MEDICARE: ELECTRA CHANTE BRADSHAW GRAHAM MD

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	207V00000X	Obstetrics & Gynecology Physician	33080	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275848897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELECTRA CHANTE BRADSHAW GRAHAM MD

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE STE 300
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2899
Country	:	US
Telephone Number	:	864-522-8603
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 ROBERTS BRANCH PKWY
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-9144
Country	:	US
Telephone Number	:	803-567-7508
Fax Number	:	803-567-7509

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

Provider Enumeration Date	:	08/09/2010
Last Update Date	:	03/09/2026

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