Provider Demographics
NPI:1316274277
Name:GRAHL, DANIEL KENDALL III (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:KENDALL
Last Name:GRAHL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAN
Other - Middle Name:K
Other - Last Name:GRAHL
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE STE 1700
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3087
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:
Practice Address - Street 1:440 CHARTER BLVD STE 3302
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-0711
Practice Address - Country:US
Practice Address - Phone:782-005-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA82451207X00000X, 207X00000X
MS25396207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery