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NPI Code Detail

MEDICARE: MR. LEE GRAHAM RAUDENBUSH PA

MEDICARE: MR. LEE GRAHAM RAUDENBUSH 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
1363A00000XPhysician Assistant001-01241NC

General Provider Information

NPI Number : 1811957111
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LEE GRAHAM RAUDENBUSH PA
Provider Business Mailing Address
First Line : 5804 HIBERNIA DR
Second Line :
City : FAYETTEVILLE
State : NC
Zip : 28314-1302
Country : US
Telephone Number : 910-488-8055
Fax Number :
Provider Business Practice Location Address
First Line : 3425 MELROSE RD
Second Line : BEHAVIORAL HEALTH CARE
City : FAYETTEVILLE
State : NC
Zip : 28304-1608
Country : US
Telephone Number : 910-615-3738
Fax Number : 910-609-3784
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 04/17/2009

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