Provider Demographics
NPI:1275192775
Name:MCGRAW, CARMEN DIANE (PA)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:DIANE
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 BIG SKY DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:GA
Mailing Address - Zip Code:31811-6537
Mailing Address - Country:US
Mailing Address - Phone:706-566-5033
Mailing Address - Fax:
Practice Address - Street 1:350 MANCHESTER EXPY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6435
Practice Address - Country:US
Practice Address - Phone:706-243-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002279363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical