MEDICARE: DR. ONA GRAHAM, PC

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	103TB0200X	Cognitive & Behavioral Psychologist	PSY001682	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790959641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ONA GRAHAM, PC

Provider Business Mailing Address
First Line	:	1443 17TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2029
Country	:	US
Telephone Number	:	706-317-2163
Fax Number	:	706-317-2176

Provider Business Practice Location Address
First Line	:	1443 17TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2029
Country	:	US
Telephone Number	:	706-317-2163
Fax Number	:	706-317-2176

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. ONA GRAHAM
Credential	:	PSY D
Telephone Number	:	706-317-2163

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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