Provider Demographics
NPI:1295565638
Name:GRANDIN, ABIGAIL (NP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:GRANDIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 BARNSLEY DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-8235
Mailing Address - Country:US
Mailing Address - Phone:706-726-0831
Mailing Address - Fax:
Practice Address - Street 1:107 WALNUT LN STE 101
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29860-8629
Practice Address - Country:US
Practice Address - Phone:803-202-7159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN295260363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner