Individual
MARK L GRAVLEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 HOSPITAL BOULEVARD, SUITE 420, ROSWELL, GA 30076-4919
(770) 410-4661
(770) 410-4664
Mailing address
2500 HOSPITAL BLVD STE 290, ROSWELL, GA 30076-4918
(470) 956-4560
(770) 475-8968
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
034355
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000454902D
—
GA
05
—
000454902E
—
GA
Enumeration date
09/16/2006
Last updated
10/14/2019
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