Individual
JULIE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
790A DAPHNE AVE, DAPHNE, AL 36526-4657
(251) 408-9287
(800) 721-2101
Mailing address
314 WHITING CT, DAPHNE, AL 36526-4616
(251) 408-9287
(800) 721-2101
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1917
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
515-45356
BCBS DAPHNE LOCATION
AL
01
—
51542827
BCBS
AL
01
—
L223
MEDICARE GROUP
AL
Enumeration date
06/19/2007
Last updated
07/02/2020
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