Provider Demographics
NPI:1548325483
Name:MUSSER GRANSKI, JANET
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:MUSSER GRANSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:GRANSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:110 NORTH BEND COURT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238
Mailing Address - Country:US
Mailing Address - Phone:770-841-0137
Mailing Address - Fax:
Practice Address - Street 1:110 NORTH BEND COURT
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238
Practice Address - Country:US
Practice Address - Phone:770-841-0137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
GACSW0041441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000891734AMedicaid