MEDICARE: JOHN ALLAN GRAHAM M.DIV., TH.M., LPC

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	101YP2500X	Professional Counselor	LPC1241	GA

General Provider Information

NPI Number	:	1386864494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN ALLAN GRAHAM M.DIV., TH.M., LPC

Provider Business Mailing Address
First Line	:	1955 CLIFF VALLEY WAY NE
Second Line	:	SUITE 215
City	:	ATLANTA
State	:	GA
Zip	:	30329-2476
Country	:	US
Telephone Number	:	404-633-0321
Fax Number	:	404-636-9889

Provider Business Practice Location Address
First Line	:	1955 CLIFF VALLEY WAY NE
Second Line	:	SUITE 215
City	:	ATLANTA
State	:	GA
Zip	:	30329-2476
Country	:	US
Telephone Number	:	404-633-0321
Fax Number	:	404-636-9889

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

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	07/08/2007

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