Granite Mountain Neurology, PC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

23522 Issued in AZ

Legal business name

GRANITE MOUNTAIN NEUROLOGY, PC

Practice address

802 Ainsworth Dr
Suite B
Prescott, AZ 86301-1630

Phone

(928) 771-2338

Fax

(928) 771-2339

NPI assigned

Mar 21, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Donald A Golen, M.D.

Title

President

Phone

(928) 771-2338

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1194784900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 AINSWORTH DR",
            "address_2": "SUITE B",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011630",
            "telephone_number": "928-771-2338",
            "fax_number": "928-771-2339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 AINSWORTH DR",
            "address_2": "SUITE B",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011630",
            "telephone_number": "928-771-2338",
            "fax_number": "928-771-2339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE MOUNTAIN NEUROLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-21",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "GOLEN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-771-2338",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "AZ",
            "license": "23522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Ann Graham, M.D.
• Cary Eugene Graller, LMT
• Damon John Grandy, PT, DPT
• Granite Mountain Health LLC (NowPrimary.Care)
• Granite Mountain Medical, PLLC (Prescott Urgent Care)
• Granite Orthopaedics, PLLC
• Granite View Adult Care Home LLC
• April Gray, LMSW
• Dee Gray, LCSW
• Jennifer Diane Gray, LCSW

• Neurology Physician in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Neurology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.