Provider Demographics
NPI:1003896580
Name:GRAHAM, DONNA MELISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MELISSA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5302
Mailing Address - Country:US
Mailing Address - Phone:501-420-1085
Mailing Address - Fax:501-420-1457
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-420-1085
Practice Address - Fax:501-420-1457
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1260207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131802001Medicaid
ARA010OtherCHAMPUS
AR5K499Medicare PIN
ARA010OtherCHAMPUS