Provider Demographics
NPI:1730429150
Name:GRAEBER, JOHN C JR (CAA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:GRAEBER
Suffix:JR
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 ALDEN AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2006
Mailing Address - Country:US
Mailing Address - Phone:404-384-2907
Mailing Address - Fax:
Practice Address - Street 1:6335 HOSPITAL PKWY STE LL17
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1549
Practice Address - Country:US
Practice Address - Phone:404-778-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
GA6914367H00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant