Active NPI
Shante Grant
- Behavior Technician
- Evans, GA
National Provider Identifier
1245716448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 18-58385
- Practice address
- 4216 Washington Rd Ste 2
Evans, GA 30809-4717 - Phone
- (762) 222-7629
- NPI assigned
- Jul 11, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 18-58385 | GA | Primary |
Addresses
Primary practice location
4216 Washington Rd Ste 2
Evans, GA 30809-4717
Mailing address
2580 Lin DO CT
Sumter, SC 29150-1832
Phone (803) 905-4427
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18-58385 | GA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531267200000",
"number": "1245716448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2580 LIN DO CT",
"city": "SUMTER",
"state": "SC",
"postal_code": "291501832",
"telephone_number": "803-905-4427",
"fax_number": "803-905-4431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4216 WASHINGTON RD STE 2",
"city": "EVANS",
"state": "GA",
"postal_code": "308094717",
"telephone_number": "762-222-7629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "SHANTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-11",
"last_updated": "2018-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "18-58385",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evans, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.