Healthcare Provider Details

I. General information

NPI: 1528339645
Provider Name (Legal Business Name): THE GRAIVIER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 OLD MILTON PARKWAY SUITE 260
ALPHARETTA GA
30005-4626
US

IV. Provider business mailing address

3333 OLD MILTON PARKWAY SUITE 260
ALPHARETTA GA
30005-4626
US

V. Phone/Fax

Practice location:
  • Phone: 770-772-0695
  • Fax: 770-751-0409
Mailing address:
  • Phone: 770-772-0695
  • Fax: 770-751-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number060245
License Number StateGA

VIII. Authorized Official

Name: DR. MILES GRAIVIER
Title or Position: OWNER
Credential: M.D.
Phone: 770-751-0695