Individual
JACK GREGORY GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
212 THOMPSON ST, HENDERSONVILLE, NC 28792-2841
(610) 703-7396
(610) 703-7396
Mailing address
212 THOMPSON ST, HENDERSONVILLE, NC 28792-2841
(610) 703-7396
(610) 703-7396
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2025-01997
NC
207XS0106X
Orthopaedic Hand Surgery Physician
2025-01997
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01092322A
STATE LICENSE
IN
01
—
2025-01997
STATE MEDICAL LICENSE
NC
05
—
300085092
—
IN
Enumeration date
04/10/2019
Last updated
07/31/2025
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