Healthcare Provider Details

I. General information

NPI: 1427041664
Provider Name (Legal Business Name): JUSTIN C. GRAFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 BRUNSON DR
TUPELO MS
38801-4948
US

IV. Provider business mailing address

609 BRUNSON DR
TUPELO MS
38801-4948
US

V. Phone/Fax

Practice location:
  • Phone: 662-844-7021
  • Fax: 662-842-5207
Mailing address:
  • Phone: 662-844-7021
  • Fax: 662-842-5207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number15750
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: