Provider Demographics
NPI:1386272938
Name:PRICE, GRANT (PA-C)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:
Last Name:PRICE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 COURT ST STE 104
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-8768
Mailing Address - Country:US
Mailing Address - Phone:989-701-2293
Mailing Address - Fax:989-701-2297
Practice Address - Street 1:621 COURT ST STE 104
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-8768
Practice Address - Country:US
Practice Address - Phone:989-701-2293
Practice Address - Fax:989-701-2297
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601009872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant