Individual
BRODERICK GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2511 GARY ST, WINNSBORO, LA 71295-2339
(318) 439-9655
Mailing address
2411 GARY ST, WINNSBORO, LA 71295-2326
(318) 439-9655
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/12/2016
Last updated
05/25/2018
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