NPIMap

Organization Active NPI

Grayson Pediatrics, LLC

  • Pediatrics Physician
  • Loganville, GA
National Provider Identifier
1831500370
Registry record updated Oct 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
057218 Issued in GA
Legal business name
GRAYSON PEDIATRICS, LLC
Practice address
297 Cooper Rd
Loganville, GA 30052-2518
Phone
(678) 381-2630
Fax
(678) 381-2627
NPI assigned
May 19, 2014
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Julie A Opeka, CPNPNPI 1831365964
Title
NP, Cfo
Phone
(678) 381-2630

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Corporate family (same tax ID) 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 20

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

View all 20

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240613002043 GA Part B Supplier - Clinic/Group Practice 1759824154 Receives reassigned benefits from 4 practitioners
Practice locations: Loganville, GA; Monroe, GA

National Provider Directory

National Provider Directory
Tax ID family
Grayson Pediatrics LLC (2 organizations share this tax ID)

Locations

297 Cooper Rd
Loganville, GA 30052
Phone (678) 381-2627

80 Parker Dr
Monroe, GA 30656
Phone (678) 381-2630

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208000000X 057218 GA Primary
Pediatric Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP0200X RN154025 GA

Addresses

NPPES NPI Registry

Primary practice location

297 Cooper Rd
Loganville, GA 30052-2518

Mailing address

297 Cooper Rd
Loganville, GA 30052-2518
Phone (678) 381-2630

Other practice location 1

80 Parker Dr
Monroe, GA 30656-4747
Phone (678) 381-2630

Other identifiers 7

NPPES NPI Registry
IdentifierTypeStateIssuer
003172811AMedicaidGA
1831365964MedicaidGA
003109575EMedicaidGA
003172811DMedicaidGA
003191294BMedicaidGA
003215265AMedicaidGA
452405206MMedicaidGA

Electronic endpoints 1

NPPES NPI Registry
TypeEndpointUseAffiliation
Direct Messaging Address grayson.office.1@28046.direct.athenahealth.com Direct

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 13, 2025.

{
    "created_epoch": "1400457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760313600000",
    "number": "1831500370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "297 COOPER RD",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522518",
            "telephone_number": "678-381-2630",
            "fax_number": "678-381-2627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "297 COOPER RD",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522518",
            "telephone_number": "678-381-2630",
            "fax_number": "678-381-2627"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "80 Parker Dr",
            "address_purpose": "LOCATION",
            "city": "Monroe",
            "state": "GA",
            "postal_code": "306564747",
            "country_code": "US",
            "telephone_number": "678-381-2630",
            "fax_number": "678-381-2627",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRAYSON PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-19",
        "last_updated": "2025-10-13",
        "certification_date": "2025-10-13",
        "status": "A",
        "authorized_official_last_name": "OPEKA",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "NP, CFO",
        "authorized_official_telephone_number": "678-381-2630",
        "authorized_official_credential": "CPNP"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "057218",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN154025",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003172811A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831365964",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003109575E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003172811D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003191294B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003215265A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "452405206M",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "grayson.office.1@28046.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "297 Cooper Rd",
            "city": "Loganville",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300522518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Loganville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.