Provider Demographics
NPI:1932170701
Name:GRAGG, JAMES MURIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MURIEL
Last Name:GRAGG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:511 CROSS ANCHOR RD
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-2328
Practice Address - Country:US
Practice Address - Phone:864-278-6031
Practice Address - Fax:864-560-5195
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC173449Medicaid
SC5892646OtherAETNA
SC5892646OtherAETNA
SCAA48076084Medicare UPIN
SCP00196239Medicare PIN
SCAA48074862Medicare PIN