Healthcare Provider Details

I. General information

NPI: 1790636355
Provider Name (Legal Business Name): AMBER LAUREN GRAHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 N MAIN ST
HILTON HEAD ISLAND SC
29926-6613
US

IV. Provider business mailing address

20 BENTON CIR
BLUFFTON SC
29910-4551
US

V. Phone/Fax

Practice location:
  • Phone: 843-681-3777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number31508
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: