Provider Demographics
NPI:1659487981
Name:GRAHAM, WILLIAM ALEXANDER IV (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALEXANDER
Last Name:GRAHAM
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-983-4346
Mailing Address - Fax:336-985-5101
Practice Address - Street 1:216 MOORE RD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-8703
Practice Address - Country:US
Practice Address - Phone:336-983-4346
Practice Address - Fax:336-985-5101
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9800878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7871166OtherAETNA
NC89127G2Medicaid
080165469OtherRAILROAD MEDICARE PIN
NCA5018OtherMEDCOST
NC127G2OtherBCBSNC
NC38748OtherPARTNERS
2281077AMedicare PIN
NC7871166OtherAETNA
NC38748OtherPARTNERS
NCH21397Medicare UPIN
2281077Medicare PIN