# NICOLE GRAHAM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225576242
- **Authorized official:** CHETAN AMIN D.O. (OFFICE MANAGER/OWNER)
- **Authorized official phone:** (704) 636-5626

## Contact information

- **Practice address:** 1401 W INNES ST, SALISBURY, NC 28144-2574
- **Practice address phone:** (704) 636-5626
- **Practice address fax:** (704) 636-5641
- **Mailing address:** 1401 W INNES ST, SALISBURY, NC 28144-2574
- **Mailing address phone:** (704) 636-5626
- **Mailing address fax:** (704) 636-5641

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | 0010-07063 | NC | Yes |
| 314000000X | Skilled Nursing Facility | 0010-07063 | NC | — |

## Other

- **Enumeration date:** 02/09/2017
- **Last updated:** 02/10/2017