Provider Demographics
NPI:1790959641
Name:DR. ONA GRAHAM, PC
Entity Type:Organization
Organization Name:DR. ONA GRAHAM, PC
Other - Org Name:ONA GRAHAM, PSYD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ONA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:706-317-2163
Mailing Address - Street 1:1443 17TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2029
Mailing Address - Country:US
Mailing Address - Phone:706-317-2163
Mailing Address - Fax:706-317-2176
Practice Address - Street 1:1443 17TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2029
Practice Address - Country:US
Practice Address - Phone:706-317-2163
Practice Address - Fax:706-317-2176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001682103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00897124BMedicaid
GA00897124BMedicaid