Healthcare Provider Details

I. General information

NPI: 1447411889
Provider Name (Legal Business Name): MICHAEL CALVIN GRAVES M.S. AUDIOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 LOOP RD TUSCALOOSA VAMC
TUSCALOOSA AL
35404-5015
US

IV. Provider business mailing address

3701 LOOP RD TUSCALOOSA VAMC
TUSCALOOSA AL
35404-5015
US

V. Phone/Fax

Practice location:
  • Phone: 205-554-2822
  • Fax: 205-554-2894
Mailing address:
  • Phone: 205-554-2822
  • Fax: 205-554-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number0981A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: