Individual
MR. CHARLES EDWARD GRANT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
405 ANGEL CT, RINCON, GA 31326-5562
(912) 728-7511
(912) 729-7529
Mailing address
405 ANGEL CT, RINCON, GA 31326-5562
(912) 728-7511
(912) 729-7529
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT001167
GA
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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