Provider Demographics
NPI:1497918171
Name:GRATTON, KRISTIAN DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KRISTIAN
Middle Name:DAVID
Last Name:GRATTON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2733 11TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1751
Mailing Address - Country:US
Mailing Address - Phone:603-548-7697
Mailing Address - Fax:
Practice Address - Street 1:995 9TH AVE SW
Practice Address - Street 2:STE EMERGENCY DEPARTMENT
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4527
Practice Address - Country:US
Practice Address - Phone:205-481-7894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL576363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical