Organization
GRANT CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLYMPIA TUCKER (OFFICE MANAGER)
(256) 728-4219
Entity
Organization
Contact information
Practice address
91 2ND AVE, GRANT, AL 35747
(256) 728-4219
(256) 728-7793
Mailing address
PO BOX 429, GRANT, AL 35747-0429
(256) 728-4219
(256) 728-7793
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3517
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529600280
—
AL
Enumeration date
03/09/2007
Last updated
08/04/2009
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