Provider Demographics
NPI:1083422240
Name:GRANT, PATRICK S SR
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:S
Last Name:GRANT
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 IVY LOOP
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7123
Mailing Address - Country:US
Mailing Address - Phone:706-615-0514
Mailing Address - Fax:
Practice Address - Street 1:1135 13TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2248
Practice Address - Country:US
Practice Address - Phone:706-887-5030
Practice Address - Fax:706-243-1877
Is Sole Proprietor?:No
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)