Provider Demographics
NPI:1821081860
Name:GRAHAM, ERROL G (MD)
Entity Type:Individual
Prefix:DR
First Name:ERROL
Middle Name:G
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:105 E TOLLISON ST STE C
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0150
Practice Address - Country:US
Practice Address - Phone:912-367-4122
Practice Address - Fax:912-367-4136
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110148141OtherRAILROAD MEDICARE
GA11BDLZLMedicaid
E83487Medicare UPIN
GA11BDLZLMedicaid