MEDICARE: JOHN GRAHAM CHARLES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9102210	FL

General Provider Information

NPI Number	:	1255308284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN GRAHAM CHARLES PA

Provider Business Mailing Address
First Line	:	700 ZEAGLER DR
Second Line	:	SUITE 8
City	:	PALATKA
State	:	FL
Zip	:	32177-6806
Country	:	US
Telephone Number	:	386-328-4242
Fax Number	:	386-328-4244

Provider Business Practice Location Address
First Line	:	700 ZEAGLER DR
Second Line	:	SUITE 8
City	:	PALATKA
State	:	FL
Zip	:	32177-6806
Country	:	US
Telephone Number	:	386-328-4242
Fax Number	:	386-328-4244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	08/16/2016

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Directions to “ JOHN GRAHAM CHARLES PA” Practice Location

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