Provider Demographics
NPI:1295308443
Name:GRAHAM-WELLS, LASHAWNDA
Entity type:Individual
Prefix:
First Name:LASHAWNDA
Middle Name:
Last Name:GRAHAM-WELLS
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 1:2736 OLD US HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27846-9664
Mailing Address - Country:US
Mailing Address - Phone:252-413-9899
Mailing Address - Fax:252-310-1079
Practice Address - Street 1:2736 OLD US HIGHWAY 64
Practice Address - Street 2:
Practice Address - City:JAMESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27846-9664
Practice Address - Country:US
Practice Address - Phone:252-413-9899
Practice Address - Fax:252-310-1079
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center