Provider Demographics
NPI:1891860169
Name:GRAHAM, BRACY B II (CRNA)
Entity Type:Individual
Prefix:
First Name:BRACY
Middle Name:B
Last Name:GRAHAM
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3025 SHARPSBURG MCCULLUM RD
Mailing Address - Street 2:BLDG B
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-6107
Mailing Address - Country:US
Mailing Address - Phone:770-251-2060
Mailing Address - Fax:770-251-8567
Practice Address - Street 1:1755 HIGHWAY 34 E
Practice Address - Street 2:SUITE 1100
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-5631
Practice Address - Country:US
Practice Address - Phone:770-252-7510
Practice Address - Fax:770-252-7511
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN169732367500000X
TX50304367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
S86642Medicare UPIN