Healthcare Provider Details

I. General information

NPI: 1982828034
Provider Name (Legal Business Name): ANN SHERYL DRAYTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 PROFESSIONAL DR 270
LAWRENCEVILLE GA
30045-3333
US

IV. Provider business mailing address

491 CONGRESS PKWY
LAWRENCEVILLE GA
30044-4547
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-3700
  • Fax:
Mailing address:
  • Phone: 678-697-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number49512
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: