Healthcare Provider Details

I. General information

NPI: 1720441587
Provider Name (Legal Business Name): KATHERINE ROSE DEGRAAFF DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 09/14/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

1001 JOHNSON FERRY RD
ATLANTA GA
30342-1605
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax: 404-785-3808
Mailing address:
  • Phone:
  • Fax: 404-785-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License NumberDO034987
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number96607
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: