Provider Demographics
NPI:1548230550
Name:REID, GRAHAM MACK (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:MACK
Last Name:REID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:10816 EXECUTIVE CENTER DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4384
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:SUITE 101
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4384
Practice Address - Country:US
Practice Address - Phone:501-221-3331
Practice Address - Fax:501-221-3339
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-54462084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR105171001Medicaid
54317Medicare ID - Type Unspecified
AR105171001Medicaid