Individual
DERAINE H GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2225 US HIGHWAY 41 N, TIFTON, GA 31794
(229) 391-4100
(229) 391-4508
Mailing address
2225 US HWY 41 N, TIFTON, GA 31794
(229) 391-4100
(229) 391-4508
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN072968
GA
Other
Enumeration date
08/30/2006
Last updated
03/18/2008
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