Individual
JOHN GRAVGAARD
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MPAS, PA-C
Contact information
Practice address
655 7TH ST, 78 MDG/SGOMF, ROBINS AFB, GA 31098-2227
(478) 327-7880
Mailing address
310 SWEET BAY RD, KATHLEEN, GA 31047-2127
(478) 224-0294
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1028021
—
Other
Enumeration date
11/17/2005
Last updated
07/08/2007
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