Healthcare Provider Details

I. General information

NPI: 1447230461
Provider Name (Legal Business Name): ERINNE AYANNA GRAHAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERINNE GRAHAM HARGRAVE MD

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N OAK AVE
MARSHFIELD WI
54449-5703
US

IV. Provider business mailing address

488 NORTHGATE PKWY
NEWNAN GA
30265-2439
US

V. Phone/Fax

Practice location:
  • Phone: 715-387-5511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number15616
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number61590
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number340063
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: