Individual
CARLY GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1 COOPER PLZ, CAMDEN, NJ 08103-1461
(855) 632-2667
Mailing address
426 KINGSTON DR, CHERRY HILL, NJ 08034-1630
(570) 362-3148
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
25MP00245000
NJ
Other
Enumeration date
10/19/2010
Last updated
03/07/2022
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