Provider Demographics
NPI:1780817817
Name:GROFF, PEYTON LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PEYTON
Middle Name:LEE
Last Name:GROFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 W PEACHTREE ST NW APT 7E
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3409
Mailing Address - Country:US
Mailing Address - Phone:317-650-1047
Mailing Address - Fax:
Practice Address - Street 1:140 E MARIETTA ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-3013
Practice Address - Country:US
Practice Address - Phone:770-213-3594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003925103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist