Healthcare Provider Details

I. General information

NPI: 1083026066
Provider Name (Legal Business Name): GRAYSON PEDIATRICS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 GRAYSON HWY SUITE A
GRAYSON GA
30017-1766
US

IV. Provider business mailing address

2065 GRAYSON HWY SUITE A
GRAYSON GA
30017-1766
US

V. Phone/Fax

Practice location:
  • Phone: 404-271-0709
  • Fax:
Mailing address:
  • Phone: 404-271-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE ANN OPEKA
Title or Position: OWNER
Credential:
Phone: 404-271-0709