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NPI Code Detail

MEDICARE: GLORIA GRAHAM M.D.

MEDICARE: GLORIA GRAHAM 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
1207Q00000XFamily Medicine PhysicianA145497CA
2207Q00000XFamily Medicine Physician27211MS

General Provider Information

NPI Number : 1932519964
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLORIA GRAHAM M.D.
Provider Business Mailing Address
First Line : 24345 HIGHWAY 15
Second Line :
City : UNION
State : MS
Zip : 39365-8575
Country : US
Telephone Number : 601-774-8211
Fax Number :
Provider Business Practice Location Address
First Line : 24345 HIGHWAY 15
Second Line :
City : UNION
State : MS
Zip : 39365-8575
Country : US
Telephone Number : 601-774-8211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/29/2014
Last Update Date : 05/24/2022

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Directions to “ GLORIA GRAHAM M.D.” Practice Location

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