Organization
STATESBORO NEUROSURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD V GRAHAM D.O. (NEUROSURGEON)
(912) 871-7777
Entity
Organization
Contact information
Practice address
1211 MERCHANT WAY STE 401, STATESBORO, GA 30458-0867
(912) 871-7777
(912) 871-7172
Mailing address
1211 MERCHANT WAY STE 401, STATESBORO, GA 30458-0867
(912) 871-7777
(912) 871-7172
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
057629
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
897954893A
—
GA
Enumeration date
10/15/2008
Last updated
10/15/2008
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