Healthcare Provider Details

I. General information

NPI: 1467773838
Provider Name (Legal Business Name): VERONICA A KON GRAVERSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VERONICA A. KON-JARA M.D.

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 BAPTIST CIR STE 400
MADISON MS
39110-2033
US

IV. Provider business mailing address

1026 BAPTIST CIR STE 400
MADISON MS
39110-2033
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-4091
  • Fax:
Mailing address:
  • Phone: 601-981-4091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0108X
TaxonomyUveitis and Ocular Inflammatory Disease (Ophthalmology) Physician
License Number37491
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number37491
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number37491
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: