Provider Demographics
NPI:1649880667
Name:GRAYSON PEDIATRICS MOBILE
Entity type:Organization
Organization Name:GRAYSON PEDIATRICS MOBILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER, CO-OWNER, CPNP
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:OPEKA
Authorized Official - Suffix:
Authorized Official - Credentials:CPNP
Authorized Official - Phone:888-778-2429
Mailing Address - Street 1:297 COOPER RD STE B
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-2518
Mailing Address - Country:US
Mailing Address - Phone:888-778-2429
Mailing Address - Fax:470-410-8905
Practice Address - Street 1:297 COOPER RD STE B
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2518
Practice Address - Country:US
Practice Address - Phone:888-778-2429
Practice Address - Fax:470-410-8905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRAYSON PEDIATRICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty