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NPI Code Detail

MEDICARE: ROBERT KEITH GRAHAM MD

MEDICARE: ROBERT KEITH GRAHAM MD
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
1208D00000XGeneral Practice Physician26858GA

General Provider Information

NPI Number : 1871690271
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT KEITH GRAHAM MD
Provider Business Mailing Address
First Line : 5716 NORTHERN DANCER DR
Second Line :
City : MACON
State : GA
Zip : 31210-7413
Country : US
Telephone Number : 478-747-2208
Fax Number :
Provider Business Practice Location Address
First Line : 5995 SPRING ST
Second Line :
City : WARM SPRINGS
State : GA
Zip : 31830-2149
Country : US
Telephone Number : 800-893-9698
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 02/25/2020

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