| Doctor Name: | DR. BRUCE N GRANT |
| NPI Number: | 1255517884 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PSYD |
| License Number: | |
| Business Practice Address: | 420 Thomaston St Zebulon, GA - 302953387 |
| Business Phone Number: | 4049601282 |
| Business Fax Number: | |
| Mailing Address: | 410 Murry Park, PEACHTREE CITY |
| State: | GA |
| Postal Code: | 302692622 |
| Phone Number: | 7707102173 |
| Fax Number: | |
| NPI Enumeration Date: | 01/14/2008 |
| NPI Last Update Date: | 04/26/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |