Individual
PORTIA MAXINE GRAYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
321 PHARR ROAD, SUITE A, ATLANTA, GA 30305
(404) 917-1111
(404) 917-1113
Mailing address
321 PHARR ROAD, SUITE A, ATLANTA, GA 30305
(404) 917-1111
(404) 917-1113
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN012800
GA
Other
Enumeration date
08/12/2006
Last updated
07/08/2007
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