Provider Demographics
NPI:1528339645
Name:THE GRAIVIER CENTER
Entity type:Organization
Organization Name:THE GRAIVIER CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILES
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-751-0695
Mailing Address - Street 1:3333 OLD MILTON PARKWAY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4626
Mailing Address - Country:US
Mailing Address - Phone:770-772-0695
Mailing Address - Fax:770-751-0409
Practice Address - Street 1:3333 OLD MILTON PARKWAY
Practice Address - Street 2:SUITE 260
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4626
Practice Address - Country:US
Practice Address - Phone:770-772-0695
Practice Address - Fax:770-751-0409
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE GRAIVIER CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-20
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060245261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical