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General NPI Number Information
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NPI Number | 1134707565
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Entity Type | Individual
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Provider Name | TOBY BERNARD GRAHAM JR.
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Gender | Male
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 2552 COVENTRY ST SW
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City | ATLANTA
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State | GA
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Zip | 30331-3141
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Country | US
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Telephone | 943-253-6389
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Fax |
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Provider Business Mailing Address
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Address Line | 2552 COVENTRY ST SW
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City | ATLANTA
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State | GA
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Zip | 30331-3141
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Country | US
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Telephone | 943-253-6389
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 183700000X
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Taxonomy Name | Pharmacy Technician
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License Number |
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License Number State | GA
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