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General NPI Number Information
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NPI Number | 1871749572
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Entity Type | Individual
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Provider Name | LEONA JEAN GRAHAM M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 02/05/2015
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Provider Practice Location Address
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Address Line | 1865 HONEYSUCKLE RD STE 2 SOUTHEAST ALABAMA MEDICAL CENTER- ALTACARE
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City | DOTHAN
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State | AL
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Zip | 36305-4287
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Country | US
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Telephone | 334-794-4582
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Fax | 334-671-9877
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Provider Business Mailing Address
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Address Line | 1108 ROSS CLARK CIR SOUTHEAST ALABAMA MEDICAL CENTER
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City | DOTHAN
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State | AL
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Zip | 36301-3022
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Country | US
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Telephone | 334-794-4582
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Fax | 334-671-9877
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 33645
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License Number State | AL
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