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General NPI Number Information
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NPI Number | 1730703422
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Entity Type | Organization
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Legal Business Name | GRAHAM 4 ENTERPRISES
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 08/30/2024
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Provider Practice Location Address
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Address Line | 1914 J N PEASE PL STE 144
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City | CHARLOTTE
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State | NC
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Zip | 28262-4504
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Country | US
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Telephone | 704-412-2802
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Fax |
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Provider Business Mailing Address
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Address Line | 9311 JW CLAY BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28262-5411
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Country | US
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Telephone | 704-412-2802
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Fax | 336-203-2092
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELYSA GRAHAM
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Credential | DNP, FNP-C
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Telephone | 704-412-2802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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