Individual
RENITA CONSTANCE GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
4500 STUART ST, MONCRIEF ARMY COMMUNITY HOSPTIAL, ATTN: MCXL-PQ, FORT JACKSON, SC 29207-5720
(803) 751-2618
(803) 751-2689
Mailing address
4500 STUART ST, MONCRIEF ARMY COMMUNITY HOSPTIAL, ATTN: MCXL-PQ, FORT JACKSON, SC 29207-5720
(803) 751-2618
(803) 751-2689
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
LD002557
GA
Other
Enumeration date
09/20/2006
Last updated
07/08/2007
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