Individual
MILDRED GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
255 SUMNER LAKES RD, SUMNER, GA 31789-4431
(229) 288-2185
Mailing address
255 SUMNER LAKES RD, SUMNER, GA 31789-4431
(229) 288-2185
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
159125
GA
Other
Enumeration date
04/30/2015
Last updated
04/30/2015
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