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General NPI Number Information
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NPI Number | 1013896745
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Entity Type | Individual
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Provider Name | GREGORY GRAVES JR. CAA
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Gender | Male
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Dates
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Enumeration Date | 08/27/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 3501 JOHNSON ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5421
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Country | US
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Telephone | 954-939-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 4895 SHALIMAR LN APT 11102
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City | DAVIE
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State | FL
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Zip | 33328-7168
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Country | US
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Telephone | 321-543-1516
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | AA1152
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License Number State | FL
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