Healthcare Provider Details

I. General information

NPI: 1093445975
Provider Name (Legal Business Name): GRAHAM ADAMS KERCHER PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 EAGLES LANDING PKWY STE 130
STOCKBRIDGE GA
30281-9091
US

IV. Provider business mailing address

33900 HARPER AVE STE 104
CLINTON TWP MI
48035-4258
US

V. Phone/Fax

Practice location:
  • Phone: 470-369-5770
  • Fax: 470-369-5771
Mailing address:
  • Phone: 586-350-2644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT015917
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: