Individual
GRANT CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1327 CLIFTON RD NE, ATLANTA, GA 30322-1013
(404) 778-3307
Mailing address
1327 CLIFTON RD NE, ATLANTA, GA 30322-1013
(404) 778-3307
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
025122
GA
2086X0206X
Surgical Oncology Physician
025122
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000462866A
—
GA
01
—
020020048
RAILROAD MEDICARE
GA
01
—
1241805
UNITED HEALTHCARE
GA
01
—
497338
BCBS
GA
01
—
515148
US HEALTHCARE
GA
01
—
Y 19930601
PHCS
GA
Enumeration date
07/26/2006
Last updated
02/19/2019
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