Provider Demographics
NPI:1063668416
Name:GRAU, BARRY L (MED)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:L
Last Name:GRAU
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4260
Mailing Address - Country:US
Mailing Address - Phone:678-592-1003
Mailing Address - Fax:
Practice Address - Street 1:3985 STEVE REYNOLDS BLVD
Practice Address - Street 2:BUILDING G
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3035
Practice Address - Country:US
Practice Address - Phone:770-622-2532
Practice Address - Fax:770-622-2534
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP000464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP000464OtherSTATE LICENSE