Individual
ANITRA SIMONE GRAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
15 REINHARDT COLLEGE PKWY, SUITE 108, CANTON, GA 30114-5257
(678) 493-2527
(678) 492-5608
Mailing address
15 REINHARDT COLLEGE PKWY, SUITE 108, CANTON, GA 30114-5257
(678) 493-2527
(678) 493-5608
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
49799
GA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
01078528A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
049799
GA
207RP1001X
Pulmonary Disease Physician
Primary
049799
GA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
49799
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
289374423A
—
GA
Enumeration date
07/12/2006
Last updated
03/17/2018
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