GRAHAM PEDIATRICS OF WOODSTOCK LLC
NPI 1316485717
Pediatrics in Woodstock, GA

Q: What is Graham Pediatrics Of Woodstock LLC's NPI number?

The NPI number for Graham Pediatrics Of Woodstock LLC is 1316485717. It was assigned to this organization in the NPPES registry on February 6, 2017.

Q: What is Graham Pediatrics Of Woodstock LLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Active since February 06, 2017CLIA 11D2077893 · Waiver

105 MIRRAMONT LAKE DR, WOODSTOCK, GA 30189(770) 485-9670 Get Directions Write a Review

NPPES record last updated: February 6, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Graham Pediatrics Of Woodstock Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRAHAM PEDIATRICS OF WOODSTOCK LLC (NPI 1316485717) is a healthcare organization registered as a pediatrics in Woodstock, Georgia and active in the NPI registry since February 2017. The organization holds a CLIA Waiver certificate valid through May 15, 2028 and lists Fitzroy Henry Graham, Owner, as its authorized official.

NPPES Registry Identity

NPI1316485717

Entity TypeOrganization

Primary Taxonomy208000000X

Legal Business NameGRAHAM PEDIATRICS OF WOODSTOCK LLC

Location Address105 MIRRAMONT LAKE DRWoodstock, GA 30189-8214

Mailing Address105 Mirramont Lake DrWoodstock, GA 30189-8214 · (770) 485-9670

Phone(770) 485-9670

Organization SubpartNo

Authorized OfficialFitzroy Henry GrahamOwner · (770) 485-9670

Enumeration DateFebruary 6, 2017

✔ NPI 1316485717 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

License✔ Licensed in GA · 48780

Definition

A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.

105 MIRRAMONT LAKE DR, Woodstock, GA 30189

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Other Identifiers 1

Medicaid000919663BGA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2077893

Graham Pediatrics Of Woodstock · Woodstock, GA

Active · expires May 15, 2028

CLIA Number11D2077893

Laboratory TypePhysician Office

Certificate Effective DateMay 16, 2026

Certificate Expiration DateMay 15, 2028

Laboratory DirectorMaylor Graham

Laboratory Phone(770) 485-9670

Laboratory LocationGraham Pediatrics Of Woodstock105 Mirramont Lake Drive, Woodstock, GA 30189

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MOLLY TEELING BRADSHAW RN

Registered Nurse