Charles Edward Grant Jr., ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT001167 Issued in GA

Practice address

405 Angel CT
Rincon, GA 31326-5562

Phone

(912) 728-7511

Fax

(912) 729-7529

NPI assigned

Sep 16, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1284595200000",
    "number": "1487962015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 ANGEL CT",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313265562",
            "telephone_number": "912-728-7511",
            "fax_number": "912-729-7529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 ANGEL CT",
            "city": "RINCON",
            "state": "GA",
            "postal_code": "313265562",
            "telephone_number": "912-728-7511",
            "fax_number": "912-729-7529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "CHARLES",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-16",
        "last_updated": "2010-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT001167",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teneka Nadia Gerido, LPC
• James R Gill, M.D.
• Kristal Gill, PMHNP-BC
• Janneska Godoy
• Amber Ivey Gordon, DMD
• Anisa D Grantham, LPC, NCAC
• David B Greenfield, M.D.
• Tiffany J Griffin, LCSW
• Jennifer Stephanie Grosse, P.T., D.P.T.,
• Danielle Marie Haggerty, M.A., CCC-SLP

• All providers in Rincon, GA
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; 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.