Individual
MRS. JILL PAYNE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-3202
Mailing address
PO BOX 602658, CHARLOTTE, NC 28260-2658
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-00161
NC
Other
Enumeration date
05/16/2006
Last updated
06/27/2012
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