# GRAHAM WELLNESS MEDICAL, P.C.

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

## Provider details

- **NPI number:** 1386941300
- **Authorized official:** DR. GORDON CHARLES DAVIS D.O. (MEDICAL DIRECTOR)
- **Authorized official phone:** (718) 566-0022

## Contact information

- **Practice address:** 104 GRAHAM AVE, BROOKLYN, NY 11206-3320
- **Practice address phone:** (718) 218-6616
- **Practice address fax:** (718) 218-6634
- **Mailing address:** 104 GRAHAM AVE, BROOKLYN, NY 11206-3320
- **Mailing address phone:** (718) 218-6616
- **Mailing address fax:** (718) 218-6634

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 171745 | NY | Yes |

## Other

- **Enumeration date:** 02/28/2011
- **Last updated:** 02/28/2011