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General NPI Number Information
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NPI Number | 1215588447
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Entity Type | Organization
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Legal Business Name | SOUTH JERSEY MEDICAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 09/29/2019
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 1304 ROUTE 47 UNIT WU-N2ND
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City | RIO GRANDE
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State | NJ
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Zip | 08242-1399
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Country | US
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Telephone | 609-451-1125
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Fax | 609-438-7944
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Provider Business Mailing Address
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Address Line | 1304 ROUTE ROUTE 47 SOUTH UNIT WU-N - 2ND FLOOR
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City | RIO GRANDE
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State | NJ
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Zip | 08242
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Country | US
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Telephone | 609-451-1125
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | JASON CHRISTOPHER GRAHAM
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Credential | APN-C
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Telephone | 609-451-1125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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