Healthcare Provider Details

I. General information

NPI: 1114714474
Provider Name (Legal Business Name): MICHAL GRAVES
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3490 INDEPENDENCE DR
HOMEWOOD AL
35209-5604
US

IV. Provider business mailing address

3490 INDEPENDENCE DR
HOMEWOOD AL
35209-5604
US

V. Phone/Fax

Practice location:
  • Phone: 205-874-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-84479
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: