Healthcare Provider Details

I. General information

NPI: 1871913517
Provider Name (Legal Business Name): YAKIA GRAHAM-FOXE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 JAVELIN CIR
EFFINGHAM SC
29541-4441
US

IV. Provider business mailing address

2619 JAVELIN CIR
EFFINGHAM SC
29541-4441
US

V. Phone/Fax

Practice location:
  • Phone: 843-615-6301
  • Fax: 843-308-1884
Mailing address:
  • Phone: 843-615-6301
  • Fax: 843-308-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number8233
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: