Provider Demographics
NPI:1235325945
Name:GRAHAM, GREG C (DC)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:C
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 JUNIPER ST NE
Mailing Address - Street 2:#108
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4128
Mailing Address - Country:US
Mailing Address - Phone:404-870-0109
Mailing Address - Fax:404-870-0108
Practice Address - Street 1:905 JUNIPER ST NE
Practice Address - Street 2:#108
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4128
Practice Address - Country:US
Practice Address - Phone:404-870-0109
Practice Address - Fax:404-870-0108
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008226111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor