Organization
ERNESTO J F GRAHAM MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERNESTO GRAHAM MD (PHYSICIAN)
(910) 223-7420
Entity
Organization
Contact information
Practice address
1521 OWEN PARK LN, FAYETTEVILLE, NC 28304-3454
(910) 223-7420
Mailing address
PO BOX 296, BRYSON CITY, NC 28713-0296
(910) 421-0010
(828) 538-4441
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127K4
BCBS
NC
01
—
5912006
MEDICAID GROUP NUMBER
NC
Enumeration date
09/06/2006
Last updated
01/11/2021
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