Provider Demographics
NPI:1083354195
Name:GRAHAM, JILL SALTINO
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SALTINO
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PINE VALLEY RD SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-4347
Mailing Address - Country:US
Mailing Address - Phone:770-547-2933
Mailing Address - Fax:
Practice Address - Street 1:30 PINE VALLEY RD SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-4347
Practice Address - Country:US
Practice Address - Phone:770-547-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator