Individual
CHARLES GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4820 FAYETTEVILLE RD, LUMBERTON, NC 28358-2112
(910) 608-0430
(910) 608-0464
Mailing address
4820 FAYETTEVILLE RD, LUMBERTON, NC 28358-2112
(910) 608-0430
(910) 608-0464
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
HC1604
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408879
—
NC
Enumeration date
02/06/2007
Last updated
10/30/2012
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