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General NPI Number Information
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NPI Number | 1972725265
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Entity Type | Individual
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Provider Name | AUDREY E. GRAHAM MD
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Gender | Female
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 3300 RIVERMONT AVE
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City | LYNCHBURG
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State | VA
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Zip | 24503-2030
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Country | US
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Telephone | 434-200-4072
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Fax | 434-200-5546
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Provider Business Mailing Address
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Address Line | 3300 RIVERMONT AVE
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City | LYNCHBURG
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State | VA
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Zip | 24503-2030
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Country | US
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Telephone | 434-200-4072
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Fax | 434-200-5546
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 000968
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0101243718
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License Number State | VA
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