Provider Demographics
NPI:1538446588
Name:GRAYSON, EMILY KRISTINE (MMS PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KRISTINE
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:MMS PA-C
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:KRISTINE
Other - Last Name:SCHLITTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:5605 GLENRIDGE DR STE 325
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1365
Mailing Address - Country:US
Mailing Address - Phone:678-553-7783
Mailing Address - Fax:678-553-7793
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-851-6323
Practice Address - Fax:404-303-3747
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant