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GRAYSON PEDIATRICS LLC NPI 1831500370


NPI Information

NPI: 1831500370
Provider Name: GRAYSON PEDIATRICS, LLC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 11D2119083

Address:
297 COOPER RD
LOGANVILLE, GA
ZIP 30052
Phone: (678) 381-2630
Get Directions

GRAYSON PEDIATRICS, LLC is a pediatrics in Loganville, GA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. GRAYSON PEDIATRICS, LLC NPI is 1831500370. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

297 COOPER RD
LOGANVILLE, GA
ZIP 30052-518
Phone: (678) 381-2630
Fax: (678) 381-2627

The provider's authorized official is Julie A Opeka .
The authorized official title is Np, Cfo and has the following contact phone number (678) 381-2630.

The CLIA number assigned to this NPI record is 11D2119083 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/19/2014 and was last updated on 8/18/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0200XNurse PractitionerPediatricsRN154025GEORGIANo
2208000000XPediatrics057218GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1452405206MMEDICAIDGEORGIA
2003215265AMEDICAIDGEORGIA
3003109575EMEDICAIDGEORGIA
4003172811AMEDICAIDGEORGIA
5003172811DMEDICAIDGEORGIA
6003191294BMEDICAIDGEORGIA
71831365964MEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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