Provider Demographics
NPI:1952331381
Name:GRAHAM, GERTRUDE DURHAM (BSN,RN)
Entity Type:Individual
Prefix:
First Name:GERTRUDE
Middle Name:DURHAM
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:BSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 PEGGY MCMILLAN DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6229
Mailing Address - Country:US
Mailing Address - Phone:770-413-2997
Mailing Address - Fax:404-728-7785
Practice Address - Street 1:1670 CLAIRMONT ROAD
Practice Address - Street 2:V A. MEDICAL CENTER (ATLANTA)
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-9819
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-728-7785
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN127664163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse