MEDICARE: MRS. SANDRA GRAHAM FNP

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	390200000X	Student in an Organized Health Care Education/Training Program	64997	SC
2	363L00000X	Nurse Practitioner	20847	SC
3	363LF0000X	Family Nurse Practitioner	20847	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4924376	OTHER	SC	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	7206002	OTHER	SC	CIGNA
4	6425288	OTHER	SC	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1851835441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA GRAHAM FNP

Provider Business Mailing Address
First Line	:	111 DOCTOR CIR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6502
Country	:	US
Telephone Number	:	800-491-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	2246 HIGHWAY 17
Second Line	:
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-9235
Country	:	US
Telephone Number	:	843-663-2220
Fax Number	:	843-663-2221

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

Provider Enumeration Date	:	12/15/2016
Last Update Date	:	09/07/2025

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