Graham Pediatrics of Woodstock LLC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

48780 Issued in GA

Legal business name

GRAHAM PEDIATRICS OF WOODSTOCK LLC

Practice address

105 Mirramont Lake Dr
Woodstock, GA 30189-8214

Phone

(770) 485-9670

NPI assigned

Feb 6, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Fitzroy Henry Graham, M.DNPI 1538120092

Title

Owner

Phone

(770) 485-9670

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Fitzroy Henry Graham, MD

  • Pediatrics Physician
  • Woodstock, GA
  • NPI 1538120092
  NPD (past) Authorized official
• Nerka Lavette Watkins-Graham, MD

  • Pediatrics Physician
  • Canton, GA
  • NPI 1619938198
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486339200000",
    "number": "1316485717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 MIRRAMONT LAKE DR",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301898214",
            "telephone_number": "770-485-9670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 MIRRAMONT LAKE DR",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301898214",
            "telephone_number": "770-485-9670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM PEDIATRICS OF WOODSTOCK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-06",
        "last_updated": "2017-02-06",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "FITZROY",
        "authorized_official_middle_name": "HENRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-485-9670",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "48780",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000919663B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evan Steve Gore, CAC II
• Patricia E. Gore, PSY.D.
• Dana Gorum
• Sidney A Gottlieb, O.D.
• Christopher Allen Goult, PT, DPT
• Fitzroy Henry Graham, MD
• Rachel Graham, NTP
• Rebecca Crawford Graham, MA, LPC, CACII
• Grainne Transportation LLC
• Samantha Liane Grant, MBBS

• Pediatrics Physician in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.