Provider Demographics
NPI:1205111952
Name:LANKFORD GRAHAM, EMILY M
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:LANKFORD GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3595 BECKY ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-5228
Mailing Address - Country:US
Mailing Address - Phone:229-292-4319
Mailing Address - Fax:
Practice Address - Street 1:3595 BECKY ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-5228
Practice Address - Country:US
Practice Address - Phone:229-292-4319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000931741AMedicaid