MEDICARE: MEDICAL CONSULTANTS OF LAKE CITY LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1538927462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL CONSULTANTS OF LAKE CITY LLC

Provider Business Mailing Address
First Line	:	56 GENESIS DR
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-5531
Country	:	US
Telephone Number	:	843-389-3685
Fax Number	:

Provider Business Practice Location Address
First Line	:	1278 MOORE ST
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-4601
Country	:	US
Telephone Number	:	843-389-3685
Fax Number	:	843-210-3026

Authorized Official
Title or Position	:	MD/OWNER
Name	:	DR. TONEY GRAHAM III
Credential	:	MD
Telephone Number	:	843-389-3685

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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