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General NPI Number Information
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NPI Number | 1831500370
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Entity Type | Organization
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Legal Business Name | GRAYSON PEDIATRICS, LLC
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Dates
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Enumeration Date | 05/19/2014
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 297 COOPER RD
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City | LOGANVILLE
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State | GA
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Zip | 30052-2518
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Country | US
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Telephone | 678-381-2630
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Fax | 678-381-2627
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Provider Business Mailing Address
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Address Line | 297 COOPER RD
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City | LOGANVILLE
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State | GA
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Zip | 30052-2518
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Country | US
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Telephone | 678-381-2630
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Fax | 678-381-2627
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Authorized Official
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Title or Position | NP, CFO
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Name | JULIE A OPEKA
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Credential | CPNP
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Telephone | 678-381-2630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN154025
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 057218
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License Number State | GA
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