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Organization
GRAHAM PEDIATRICS OF WOODSTOCK LLC
Active
Organization
GRAHAM PEDIATRICS OF WOODSTOCK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FITZROY HENRY GRAHAM M.D (OWNER)
(770) 485-9670
Entity
Organization
Contact information
Practice address
105 MIRRAMONT LAKE DR, WOODSTOCK, GA 30189-8214
(770) 485-9670
Mailing address
105 MIRRAMONT LAKE DR, WOODSTOCK, GA 30189-8214
(770) 485-9670
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
48780
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000919663B
—
GA
Enumeration date
02/06/2017
Last updated
02/06/2017
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