Healthcare Provider Details

I. General information

NPI: 1316913072
Provider Name (Legal Business Name): WILLIAM MCLAURIN GRAHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 CHARLIE HALL BLVD
CHARLESTON SC
29414-5834
US

IV. Provider business mailing address

2051 CHARLIE HALL BLVD
CHAS SC
29414-5879
US

V. Phone/Fax

Practice location:
  • Phone: 843-573-2535
  • Fax: 843-573-2534
Mailing address:
  • Phone: 843-573-2535
  • Fax: 843-573-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18368
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: