Provider Demographics
NPI:1407817554
Name:GRAIVIER, MILES H (MD)
Entity Type:Individual
Prefix:
First Name:MILES
Middle Name:H
Last Name:GRAIVIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1295 HEMBREE RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5721
Mailing Address - Country:US
Mailing Address - Phone:770-772-0695
Mailing Address - Fax:770-751-0409
Practice Address - Street 1:1295 HEMBREE RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5721
Practice Address - Country:US
Practice Address - Phone:770-772-0695
Practice Address - Fax:770-751-0409
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA034602208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE83559Medicare UPIN
GA24BCBHNMedicare ID - Type UnspecifiedMEDICARE