Crystal Dale Grantham
NPI #1336633791 in Richton, Mississippi
Provider Information
- NPI Number
- 1336633791
- Entity Type
- Individual
- Name
- Crystal Dale Grantham
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Nurse Practitioner - Family
- Enumeration Date
- Jun 19, 2018
- Last Updated
- Dec 30, 2020
Practice Location
- Address
- 210 BAY AVE
- City
- Richton
- State
- Mississippi
- ZIP Code
- 39476-9665
- Phone
- (601) 788-9222
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner - Family — Family |
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