Healthcare Provider Details

I. General information

NPI: 1760201842
Provider Name (Legal Business Name): CURTIS WAYNE GRAHAM JR. RRA, RPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N BROAD ST NE
ROME GA
30161-5201
US

IV. Provider business mailing address

754 ASTER DR
FLORENCE SC
29501-7573
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-2661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number23SC1230
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: