Individual
SUSAN LESLIE GRANVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
4945 WILLIAMS DR, GEORGETOWN, TX 78633-2008
(512) 819-0500
Mailing address
626 APACHE MOUNTAIN LN, GEORGETOWN, TX 78633-5434
(512) 943-9847
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA06979
TX
Other
Enumeration date
06/28/2007
Last updated
04/18/2011
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