MEDICARE: MR. TONEY GRAHAM JR. M.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	261QP2300X	Primary Care Clinic/Center	89530	SC
2	207Q00000X	Family Medicine Physician	08953	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	:	1669495867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TONEY GRAHAM JR. M.D.

Provider Business Mailing Address
First Line	:	1278 MOORE ST
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-4601
Country	:	US
Telephone Number	:	843-389-7251
Fax Number	:	843-389-7253

Provider Business Practice Location Address
First Line	:	1278 MOORE ST
Second Line	:
City	:	LAKE CITY
State	:	SC
Zip	:	29560-4601
Country	:	US
Telephone Number	:	843-389-7251
Fax Number	:	843-389-7253

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	04/13/2016

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