Healthcare Provider Details

I. General information

NPI: 1972601888
Provider Name (Legal Business Name): SUTTON L GRAHAM II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 HALTON RD SUITE 100
GREENVILLE SC
29607
US

IV. Provider business mailing address

615 HALTON RD SUITE 100
GREENVILLE SC
29607
US

V. Phone/Fax

Practice location:
  • Phone: 864-676-1707
  • Fax: 864-676-9256
Mailing address:
  • Phone: 864-676-1707
  • Fax: 864-676-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number11893
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: