Provider Demographics
NPI:1427041664
Name:GRAFF, JUSTIN C (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:C
Last Name:GRAFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 BRUNSON DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4948
Mailing Address - Country:US
Mailing Address - Phone:662-844-7021
Mailing Address - Fax:662-842-5207
Practice Address - Street 1:609 BRUNSON DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4948
Practice Address - Country:US
Practice Address - Phone:662-844-7021
Practice Address - Fax:662-842-5207
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS157502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0119381Medicaid
MS130000146Medicare ID - Type Unspecified
MSG08179Medicare UPIN