Healthcare Provider Details

I. General information

NPI: 1437081270
Provider Name (Legal Business Name): CARSON GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 ELM ST
AYNOR SC
29511-3007
US

IV. Provider business mailing address

PO BOX 158
AYNOR SC
29511-0158
US

V. Phone/Fax

Practice location:
  • Phone: 864-551-1730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF05260218
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: