Provider Demographics
NPI:1104828698
Name:GRAHAM, HEATH ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATH
Middle Name:ROSS
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5780 PEACHTREE DUNWOODY ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-1224
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:4800 OLDE TOWNE PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4357
Practice Address - Country:US
Practice Address - Phone:770-977-1510
Practice Address - Fax:770-509-8858
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047087207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000828484HMedicaid
GA000828484GMedicaid
GA000828484BMedicaid
GA000828484GMedicaid