Provider Demographics
NPI:1811907348
Name:GRAHAM, PATRICK DONOVAN (PT, MBA)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:DONOVAN
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PT, MBA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6453 SPRINGWATER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2982
Mailing Address - Country:US
Mailing Address - Phone:706-322-7762
Mailing Address - Fax:706-660-8316
Practice Address - Street 1:6298 VETERANS PKWY
Practice Address - Street 2:SUITE 5A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-6258
Practice Address - Country:US
Practice Address - Phone:706-322-7762
Practice Address - Fax:706-660-8316
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPTH8420OtherALABAMA LICENSE
GA2998OtherSTATE LICENSE NUMBER
GA2998OtherSTATE LICENSE NUMBER