Provider Demographics
NPI:1164788675
Name:GRADDY, RYAN NAGUMO (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NAGUMO
Last Name:GRADDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2140 PEACHTREE RD NW STE 232
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1316
Mailing Address - Country:US
Mailing Address - Phone:404-231-4431
Mailing Address - Fax:404-231-5677
Practice Address - Street 1:2140 PEACHTREE RD NW STE 232
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1316
Practice Address - Country:US
Practice Address - Phone:404-231-4431
Practice Address - Fax:404-231-5677
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA82590207R00000X
MDD79188207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine