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General NPI Number Information
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NPI Number | 1598193831
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Entity Type | Individual
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Provider Name | GRAHAM REAVES MSOT
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Gender | Male
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Dates
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Enumeration Date | 10/24/2013
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 1901 PHOENIX BLVD SUITE 120
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City | ATLANTA
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State | GA
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Zip | 30349-5063
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Country | US
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Telephone | 404-355-0743
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 W VILLAGE PL SE UNIT 2316
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City | SMYRNA
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State | GA
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Zip | 30080-9250
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Country | US
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Telephone |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT005790
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number | 005790
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License Number State | GA
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