Healthcare Provider Details

I. General information

NPI: 1053659367
Provider Name (Legal Business Name): RHONDA B GRAHAM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 04/07/2022
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5729 COVE COMMONS DR. SE SUITE C
BROWNSBORO AL
35741-9744
US

IV. Provider business mailing address

5729 COVE COMMONS DR. SE SUITE C
BROWNSBORO AL
35741-9744
US

V. Phone/Fax

Practice location:
  • Phone: 256-367-2686
  • Fax: 256-292-0114
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberUO3184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: