Provider Demographics
NPI:1215565866
Name:GRAVES, DYLAN (MD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:GRAVES
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 1:1301 FIVE OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-8150
Mailing Address - Country:US
Mailing Address - Phone:320-420-6364
Mailing Address - Fax:
Practice Address - Street 1:4700 WATERS AVENUE
Practice Address - Street 2:INTERNAL MEDICINE RESIDENCY PROGRAM
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-350-7573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program