Provider Demographics
NPI:1235303835
Name:GRAHAM, NAOMI TRACEY
Entity Type:Individual
Prefix:MRS
First Name:NAOMI
Middle Name:TRACEY
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 1:19 BENTLEY WAY
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3682
Mailing Address - Country:US
Mailing Address - Phone:864-801-3355
Mailing Address - Fax:
Practice Address - Street 1:3305 RUTHERFORD RD STE L
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2159
Practice Address - Country:US
Practice Address - Phone:864-801-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1235303835OtherNPI