Individual
GEORGE WENDELL GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(757) 953-1305
Mailing address
1840 COVE RD, VIRGINIA BEACH, VA 23459-8910
(757) 763-5952
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
04/23/2012
Last updated
04/23/2012
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