Provider Demographics
NPI:1194111666
Name:SAXTON, GRANT PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:PATRICK
Last Name:SAXTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 DEER HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-8079
Mailing Address - Country:US
Mailing Address - Phone:601-955-9896
Mailing Address - Fax:
Practice Address - Street 1:1002 JEFFERSON STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4306
Practice Address - Country:US
Practice Address - Phone:601-649-3520
Practice Address - Fax:601-649-7899
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS255952080A0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program