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General NPI Number Information
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NPI Number | 1316444912
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Entity Type | Organization
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Legal Business Name | DR. GRAHAM PSYCHIATRIC SERVICES, LLC
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 256 HONEYSUCKLE RD STE 2
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City | DOTHAN
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State | AL
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Zip | 36305-1168
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Country | US
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Telephone | 334-792-6736
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Fax | 334-792-6737
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Provider Business Mailing Address
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Address Line | 256 HONEYSUCKLE RD STE 2
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City | DOTHAN
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State | AL
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Zip | 36305-1168
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Country | US
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Telephone | 334-792-6736
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Fax | 334-792-6737
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Authorized Official
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Title or Position | OWNER
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Name | DR. LEONA J GRAHAM
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Credential | MD
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Telephone | 334-792-6736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD.33645
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License Number State | AL
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