Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 3505 | AL |
NPI | 1013125319 |
---|---|
Provider Name | Dr. Michael James Graham |
First Address | Cullman, AL 35055-2928 |
Second Address | Cullman, AL 35055-2928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |