Provider Demographics
NPI:1659710200
Name:GRAHAM, CHARLOTTE JOHNSON (DO)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:JOHNSON
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 GARNET DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-7321
Mailing Address - Country:US
Mailing Address - Phone:505-301-7802
Mailing Address - Fax:
Practice Address - Street 1:2579 CHIMNEY ROCK RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-9181
Practice Address - Country:US
Practice Address - Phone:505-301-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program