Healthcare Provider Details

I. General information

NPI: 1790898203
Provider Name (Legal Business Name): DORIS JEANNE GRACHEK M.S.-CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 PEACHTREE ST NW SUITE 200
ATLANTA GA
30309-2449
US

IV. Provider business mailing address

231 WEBNEY DR
MARIETTA GA
30068-3861
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-5045
  • Fax:
Mailing address:
  • Phone: 770-565-2487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD003368
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: