Healthcare Provider Details

I. General information

NPI: 1194054296
Provider Name (Legal Business Name): MORRIS ANGUS GRAHAM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2009
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56-660 KAMEHAMEHA HWY
KAHUKU HI
96731-2210
US

IV. Provider business mailing address

55-426 MOANA ST
LAIE HI
96762-1122
US

V. Phone/Fax

Practice location:
  • Phone: 808-293-7555
  • Fax: 808-293-7196
Mailing address:
  • Phone: 808-227-1161
  • Fax: 808-293-7196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: