Individual
SOPHIA LORRAINE GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
215 BROOK HOLLOW DR, MCDONOUGH, GA 30252-3960
(404) 431-6036
Mailing address
215 BROOK HOLLOW DR, MCDONOUGH, GA 30252-3960
(404) 431-6036
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
GA
Other
Enumeration date
09/17/2019
Last updated
09/17/2019
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