Provider Demographics
NPI:1346011970
Name:GRAVES, DONALD LYNN III (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:LYNN
Last Name:GRAVES
Suffix:III
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-4229
Mailing Address - Country:US
Mailing Address - Phone:985-974-9196
Mailing Address - Fax:
Practice Address - Street 1:210 THIRD ST
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520-4229
Practice Address - Country:US
Practice Address - Phone:985-974-9196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSAT05172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty