MEDICARE: THE GRAIVIER CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	060245	GA

General Provider Information

NPI Number	:	1528339645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GRAIVIER CENTER

Provider Business Mailing Address
First Line	:	3333 OLD MILTON PARKWAY
Second Line	:	SUITE 260
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-4626
Country	:	US
Telephone Number	:	770-772-0695
Fax Number	:	770-751-0409

Provider Business Practice Location Address
First Line	:	3333 OLD MILTON PARKWAY
Second Line	:	SUITE 260
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-4626
Country	:	US
Telephone Number	:	770-772-0695
Fax Number	:	770-751-0409

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MILES GRAIVIER
Credential	:	M.D.
Telephone Number	:	770-751-0695

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	08/11/2021

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Directions to “THE GRAIVIER CENTER ” Practice Location

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