Provider Demographics
NPI:1669997409
Name:GRAVES, ARETHA
Entity type:Individual
Prefix:
First Name:ARETHA
Middle Name:
Last Name:GRAVES
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 1:214 PITCH KETTLE RD
Mailing Address - Street 2:
Mailing Address - City:DOLPHIN
Mailing Address - State:VA
Mailing Address - Zip Code:23843-2122
Mailing Address - Country:US
Mailing Address - Phone:434-532-3502
Mailing Address - Fax:
Practice Address - Street 1:214 PITCH KETTLE RD
Practice Address - Street 2:
Practice Address - City:DOLPHIN
Practice Address - State:VA
Practice Address - Zip Code:23843-2122
Practice Address - Country:US
Practice Address - Phone:434-532-3502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-12
Last Update Date:2017-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT69506265172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver