Provider Demographics
NPI:1457480352
Name:MARTIN, GRAHAM PIGFORD (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:GRAHAM
Middle Name:PIGFORD
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7925 VANZYVERDEN RD.
Mailing Address - Street 2:A
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305
Mailing Address - Country:US
Mailing Address - Phone:601-679-9849
Mailing Address - Fax:
Practice Address - Street 1:7925 VAN ZYVERDEN RD
Practice Address - Street 2:A
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-9124
Practice Address - Country:US
Practice Address - Phone:601-679-9849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSDO932133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered