Provider Demographics
NPI:1942251285
Name:GRAHAM, TONY R (MD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:R
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:PO BOX 1657
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-1657
Mailing Address - Country:US
Mailing Address - Phone:864-225-4601
Mailing Address - Fax:864-225-6998
Practice Address - Street 1:800 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5708
Practice Address - Country:US
Practice Address - Phone:864-225-4601
Practice Address - Fax:864-225-6998
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15407207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ27048Medicaid
SCQ27048Medicaid
SCQ27048Medicaid