Healthcare Provider Details

I. General information

NPI: 1730429150
Provider Name (Legal Business Name): JOHN C GRAEBER JR. CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2013
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6335 HOSPITAL PKWY STE LL17
DULUTH GA
30097-1549
US

IV. Provider business mailing address

55 ALDEN AVE NW
ATLANTA GA
30309-2006
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-0883
  • Fax:
Mailing address:
  • Phone: 404-384-2907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number6914
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number6914
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: