Healthcare Provider Details

I. General information

NPI: 1841323649
Provider Name (Legal Business Name): BARBARA H GRAHAM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 12/15/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W MAIN STREET
ROWLAND NC
28383-9400
US

IV. Provider business mailing address

4101 W CARTHAGE RD
LUMBERTON NC
28360-9389
US

V. Phone/Fax

Practice location:
  • Phone: 910-720-1101
  • Fax:
Mailing address:
  • Phone: 910-843-3311
  • Fax: 910-843-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0101421
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0101421
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: