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General NPI Number Information
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NPI Number | 1780817817
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Entity Type | Individual
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Provider Name | PEYTON LEE GROFF PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/10/2015
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Provider Practice Location Address
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Address Line | 140 E MARIETTA ST
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City | CANTON
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State | GA
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Zip | 30114-3013
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Country | US
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Telephone | 770-213-3594
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Fax |
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Provider Business Mailing Address
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Address Line | 1270 W PEACHTREE ST NW APT 7E
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City | ATLANTA
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State | GA
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Zip | 30309-3409
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Country | US
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Telephone | 317-650-1047
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY003925
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License Number State | GA
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