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NPI Code Detail

MEDICARE: KEVIN JOEL GRAJALES

MEDICARE: KEVIN JOEL GRAJALES
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
1106S00000XBehavior TechnicianRBT-21-180397GA

General Provider Information

NPI Number : 1588301881
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN JOEL GRAJALES
Provider Business Mailing Address
First Line : 7491 MOSSDALE WAY
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-1787
Country : US
Telephone Number : 850-266-4697
Fax Number :
Provider Business Practice Location Address
First Line : 7491 MOSSDALE WAY
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-1787
Country : US
Telephone Number : 850-266-4697
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2022
Last Update Date : 05/18/2022

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Directions to “ KEVIN JOEL GRAJALES ” Practice Location

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