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General NPI Number Information
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NPI Number | 1922160761
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Entity Type | Organization
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Legal Business Name | PIEDMONT DEPARTMENT OF UROLOGY, PLLC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 350 JOHNSON RIDGE MEDICAL PARK
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City | ELKIN
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State | NC
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Zip | 28621
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Country | US
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Telephone | 336-526-6155
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Fax | 336-526-6158
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Provider Business Mailing Address
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Address Line | 350 JOHNSON RIDGE MEDICAL PARK
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City | ELKIN
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State | NC
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Zip | 28621
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Country | US
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Telephone | 336-526-6155
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Fax | 336-526-6158
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | DR. ROBERT S GRAJEWSKI
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Credential | M.D.
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Telephone | 336-526-6155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 31292
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License Number State | NC
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