MEDICARE: TOBY BERNARD GRAHAM JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		GA
2	183700000X	Pharmacy Technician		GA

General Provider Information

NPI Number	:	1134707565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOBY BERNARD GRAHAM JR.

Provider Business Mailing Address
First Line	:	2552 COVENTRY ST SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-3141
Country	:	US
Telephone Number	:	943-253-6389
Fax Number	:

Provider Business Practice Location Address
First Line	:	2552 COVENTRY ST SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-3141
Country	:	US
Telephone Number	:	943-253-6389
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	12/31/2025

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