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NPI Code Detail

MEDICARE: MR. ERIC LAMAR GRAVES SR. LICSW, PIP

MEDICARE: MR. ERIC LAMAR GRAVES SR. LICSW, PIP
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
11041C0700XClinical Social WorkerCSW005194GA
21041C0700XClinical Social Worker1099-3582CAL

General Provider Information

NPI Number : 1760804231
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERIC LAMAR GRAVES SR. LICSW, PIP
Provider Business Mailing Address
First Line : 6600 VAN AALST BLVD
Second Line :
City : FORT BENNING
State : GA
Zip : 31905-2102
Country : US
Telephone Number : 762-408-0255
Fax Number :
Provider Business Practice Location Address
First Line : 6600 VAN AALST BLVD
Second Line :
City : FORT BENNING
State : GA
Zip : 31905-2102
Country : US
Telephone Number : 706-442-5270
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2014
Last Update Date : 06/23/2026

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