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General NPI Number Information
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NPI Number | 1447768031
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Entity Type | Individual
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Provider Name | SAMANTHA ANNE GRAHAM
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Gender | Female
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 2686 W STATE ST
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City | BRISTOL
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State | TN
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Zip | 37620-1817
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Country | US
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Telephone | 423-844-0026
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 W OAKLAND AVE STE 310
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2192
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Country | US
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Telephone | 423-952-2111
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110010426
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 6247
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License Number State | TN
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