Individual
VICTORIUS VANDELLA GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
817 W VIRGINIA RD, GEORGETOWN, SC 29440-2226
(843) 359-8280
Mailing address
PO BOX 1205, GEORGETOWN, SC 29442-1205
(843) 359-8280
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
861774045
—
SD
05
—
89-1774045
—
SC
Enumeration date
07/21/2021
Last updated
07/21/2021
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