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General NPI Number Information
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NPI Number | 1275192775
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Entity Type | Individual
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Provider Name | CARMEN DIANE MCGRAW PA
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Gender | Female
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 06/07/2019
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Provider Practice Location Address
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Address Line | 350 MANCHESTER EXPY
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City | COLUMBUS
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State | GA
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Zip | 31904-6435
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Country | US
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Telephone | 706-243-0250
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Fax |
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Provider Business Mailing Address
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Address Line | 186 BIG SKY DR
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City | HAMILTON
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State | GA
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Zip | 31811-6537
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Country | US
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Telephone | 706-566-5033
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 002279
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License Number State | GA
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