Individual
GREGG TRAVIS GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
354 COPPERFIELD BLVD NE, CONCORD, NC 28025-2402
(704) 786-5122
(704) 782-8279
Mailing address
4601 PARK RD STE 300, CHARLOTTE, NC 28209-2290
(704) 323-2090
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
ARNP9332853
FL
363LF0000X
Family Nurse Practitioner
Primary
5011714
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0397730026
NSC#
NC
Enumeration date
12/11/2006
Last updated
06/04/2019
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