MEDICARE: DR. ONA GRAHAM PSY.D.

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	103G00000X	Clinical Neuropsychologist	PSY001682	GA

General Provider Information

NPI Number	:	1578597126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ONA GRAHAM PSY.D.

Provider Business Mailing Address
First Line	:	1443 17TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901
Country	:	US
Telephone Number	:	706-317-2163
Fax Number	:	706-317-2176

Provider Business Practice Location Address
First Line	:	1443 17TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2029
Country	:	US
Telephone Number	:	706-317-2163
Fax Number	:	706-317-2176

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/09/2007

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