Charles Edward Grant Jr., ATC
Specialist/Technologist, Athletic Trainer in Rincon, GA. Individual provider (NPI-1).
NPI number1487962015
StatusActive
Last updated in NPPESSep 16, 2010
Details
- NPI
- 1487962015
- Entity type
- Individual (NPI-1)
- Name
- Mr. Charles Edward Grant Jr.
- Credential
- ATC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 16, 2010
- Last updated
- Sep 16, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | AT001167 | GA | Yes |
Practice location
405 Angel CtRincon, GA 31326-5562
Phone 912-728-7511 · Fax 912-729-7529
Mailing address
405 Angel CtRincon, GA 31326-5562
Phone 912-728-7511 · Fax 912-729-7529
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