Basic Information
| Provider Information | |||||||||
| NPI: | 1598193831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REAVES | ||||||||
| FirstName: | GRAHAM | ||||||||
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| Credential: | MSOT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 PEACHTREE VALLEY RD NE | ||||||||
| Address2: | APARTMENT 1727 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066762413 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1901 PHOENIX BLVD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303495063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043550743 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2013 | ||||||||
| LastUpdateDate: | 10/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 005790 | GA | Y | Hospital Units | Rehabilitation Unit |
No ID Information.