Provider Demographics
NPI:1598377764
Name:GRAHAM, ALLISON BARNWELL
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:BARNWELL
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 S RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSHEAR
Mailing Address - State:GA
Mailing Address - Zip Code:31516-4660
Mailing Address - Country:US
Mailing Address - Phone:912-309-9716
Mailing Address - Fax:
Practice Address - Street 1:1419 S RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:BLACKSHEAR
Practice Address - State:GA
Practice Address - Zip Code:31516-4660
Practice Address - Country:US
Practice Address - Phone:912-309-9716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN258498363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily