Provider Demographics
NPI:1710611348
Name:GRAHAM, JOHN-NATHAN HOWARD
Entity Type:Individual
Prefix:
First Name:JOHN-NATHAN
Middle Name:HOWARD
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-5511
Mailing Address - Country:US
Mailing Address - Phone:865-724-0852
Mailing Address - Fax:865-724-0853
Practice Address - Street 1:1821 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-5511
Practice Address - Country:US
Practice Address - Phone:865-724-0852
Practice Address - Fax:865-724-0853
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)