Provider Demographics
NPI:1770786915
Name:GRAHAM, BELINDA KAYE (MD)
Entity type:Individual
Prefix:
First Name:BELINDA
Middle Name:KAYE
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 N. COOPER LAKE RD SE
Mailing Address - Street 2:STE 101
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4480 N COOPER LAKE RD SE STE 101
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-4623
Practice Address - Country:US
Practice Address - Phone:770-333-2027
Practice Address - Fax:770-333-2031
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0726207K00000X
390200000X
GA74822207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1180658Medicaid