Provider Demographics
NPI:1255760906
Name:GRAHAM, MAUREEN (MS, GC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MS, GC
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:OSAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:2004 HAYES ST STE 160
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2646
Practice Address - Country:US
Practice Address - Phone:615-284-2276
Practice Address - Fax:615-284-1876
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN238170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPPINPROCESSMedicaid