Individual
MARISA ROSE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1818 HENDERSON ST, COLUMBIA, SC 29201-2619
(803) 758-2602
(803) 253-8896
Mailing address
743 FOLLY RD, CHARLESTON, SC 29412-3432
(828) 762-2360
(828) 762-2340
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-01328
NC
363A00000X
Physician Assistant
Primary
1154
SC
Other
Enumeration date
05/09/2007
Last updated
11/03/2024
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