Provider Demographics
NPI:1497863674
Name:GRAHAM M REID MD PA
Entity Type:Organization
Organization Name:GRAHAM M REID MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-221-3331
Mailing Address - Street 1:10816 EXECUTIVE CENTER DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4381
Mailing Address - Country:US
Mailing Address - Phone:501-221-3331
Mailing Address - Fax:501-221-3339
Practice Address - Street 1:10816 EXECUTIVE CENTER DR
Practice Address - Street 2:#101
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4354
Practice Address - Country:US
Practice Address - Phone:501-221-3331
Practice Address - Fax:501-221-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-54462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157282002Medicaid
E68180Medicare UPIN
AR157282002Medicaid