Provider Demographics
NPI:1790898203
Name:GRACHEK, DORIS JEANNE (MS-CCC-A)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:JEANNE
Last Name:GRACHEK
Suffix:
Gender:F
Credentials:MS-CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 WEBNEY DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-3861
Mailing Address - Country:US
Mailing Address - Phone:770-565-2487
Mailing Address - Fax:
Practice Address - Street 1:1720 PEACHTREE ST NW
Practice Address - Street 2:SUITE 200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2449
Practice Address - Country:US
Practice Address - Phone:404-351-5045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003368231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist