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GRANT THOMAS LAND PA-C

Medical >> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1508816570

Individual Registrant:
 GRANT THOMAS LAND PA-C
Gender: M
Not Sole Proprietor

Location and contact information for practice:
545 VENTURE CT  MONTICELLO, GA 31064-7788 US
Tel: 706-468-7002  Fax: 877-870-3481

Contact information for business:
6175 NEWTON DR NE  COVINGTON, GA 30014-2690 US
Tel: 770-787-6900  Fax: 770-787-6962

Registration Information:
NPI: 1508816570
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363AM0700XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Medical
GA004108

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
PA LICENSE NUMBER004108GA01
003200095AGA05




HEALTH CARE JOBS GA - Page 1



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