MEDICARE: MS. KAREN T. GRAVES CAC-2

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	3657	GA

General Provider Information

NPI Number	:	1942163639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN T. GRAVES CAC-2

Provider Business Mailing Address
First Line	:	806 BEAVER CIR
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31533-2122
Country	:	US
Telephone Number	:	912-381-4841
Fax Number	:

Provider Business Practice Location Address
First Line	:	806 BEAVER CIR
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31533-2122
Country	:	US
Telephone Number	:	912-381-4841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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