Provider Demographics
NPI:1992860779
Name:GRAHAM, PAGE M (NP)
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 NASHVILLE HWY STE 12
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-2478
Mailing Address - Country:US
Mailing Address - Phone:931-981-6930
Mailing Address - Fax:
Practice Address - Street 1:833 NASHVILLE HWY STE 12
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-2478
Practice Address - Country:US
Practice Address - Phone:931-981-6930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00382682OtherRAILROAD MEDICARE
TN3346631Medicaid
TN3346631Medicare PIN