Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 200500195 | NC |
N | 207VG0400X | Gynecologist | 200500195 | NC |
N | 207VX0000X | Obstetrician | 200500195 | NC |
NPI | 1114125036 |
---|---|
Provider Name | Reta B Graham |
First Address | Asheville, NC 28801-1711 |
Second Address | Asheville, NC 28801-1711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 22/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114125036 | (05) | NC |