Provider Demographics
NPI:1396826129
Name:GRAVES, EDITH K (MD)
Entity Type:Individual
Prefix:DR
First Name:EDITH
Middle Name:K
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:EDITH
Other - Middle Name:FRASER
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 PEPPERELL PKWY
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-5452
Mailing Address - Country:US
Mailing Address - Phone:334-528-1054
Mailing Address - Fax:334-528-1667
Practice Address - Street 1:2000 PEPPERELL PKWY
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-5452
Practice Address - Country:US
Practice Address - Phone:334-528-1054
Practice Address - Fax:334-528-1667
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12882207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000080793Medicaid
ALC78856Medicare UPIN
AL000080793Medicare PIN