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General NPI Number Information
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NPI Number | 1790710093
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Entity Type | Individual
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Provider Name | JOHN MCKAY GRAHAM JR. MD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 594 LONE TREE DR BLDG 6
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City | MT PLEASANT
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State | SC
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Zip | 29464-8170
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Country | US
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Telephone | 843-958-2500
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Fax | 843-958-2680
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Provider Business Mailing Address
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Address Line | PO BOX 751649
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City | CHARLOTTE
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State | NC
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Zip | 28275-1649
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Country | US
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Telephone | 888-472-0043
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Fax | 843-724-2440
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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 | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 12856
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 12856
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 12856
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License Number State | SC
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