Provider Demographics
NPI:1083026066
Name:GRAYSON PEDIATRICS, LLC.
Entity Type:Organization
Organization Name:GRAYSON PEDIATRICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OPEKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-271-0709
Mailing Address - Street 1:2065 GRAYSON HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1766
Mailing Address - Country:US
Mailing Address - Phone:404-271-0709
Mailing Address - Fax:
Practice Address - Street 1:2065 GRAYSON HWY
Practice Address - Street 2:SUITE A
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-1766
Practice Address - Country:US
Practice Address - Phone:404-271-0709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty