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NPI Code Detail

MEDICARE: TAI'ANAH A GRAHAM

MEDICARE: TAI'ANAH A GRAHAM
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1871449652
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAI'ANAH A GRAHAM
Provider Business Mailing Address
First Line : 11050 HARTS RD APT 2002
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32218-3770
Country : US
Telephone Number : 904-487-8216
Fax Number :
Provider Business Practice Location Address
First Line : 6820 SOUTHPOINT PKWY STE 6
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-6277
Country : US
Telephone Number : 888-754-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2026
Last Update Date : 03/05/2026

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Directions to “ TAI'ANAH A GRAHAM ” Practice Location

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