Provider Demographics
NPI:1417921552
Name:GRAHAM, CARLETTE (MD, FCCP)
Entity Type:Individual
Prefix:
First Name:CARLETTE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD, FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 EAGLES LANDING PKWY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5011
Mailing Address - Country:US
Mailing Address - Phone:770-996-6699
Mailing Address - Fax:770-997-4790
Practice Address - Street 1:915 EAGLES LANDING PKWY
Practice Address - Street 2:
Practice Address - City:STOCBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5011
Practice Address - Country:US
Practice Address - Phone:770-996-6699
Practice Address - Fax:770-997-4790
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00713138BMedicaid
GA29BDCBRMedicare Oscar/Certification
GAG34987Medicare UPIN
GA00713138BMedicaid