1124189600 NPI number — DR. JACQUELINE H GRANT MD, MPH, MPA

Table of content: DR. JACQUELINE H GRANT MD, MPH, MPA (NPI 1124189600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124189600 NPI number — DR. JACQUELINE H GRANT MD, MPH, MPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANT
Provider First Name:
JACQUELINE
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MPH, MPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124189600
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNC DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Provider Second Line Business Mailing Address:
3010 OLD CLINIC BUILDING CB # 7516
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27599-7516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-966-6444
Provider Business Mailing Address Fax Number:
919-966-6377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 10TH AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31901-3703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-571-1285
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X , with the licence number:  2015-00684 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VM0101X , with the licence number: 032570 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 695415663A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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