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FITZROY HENRY GRAHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
105 MIRRAMONT LAKE DR STE 100, WOODSTOCK, GA 30189-8214
(770) 485-9670
(678) 401-7658
Mailing address
105 MIRRAMONT LAKE DR, WOODSTOCK, GA 30189-8214
(770) 485-9670
(678) 401-7658

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
048780
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000919663B
GA
Enumeration date
03/31/2006
Last updated
02/18/2021
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