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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