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Individual

MR. GARY MICHAEL GRAHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 713-2697
Mailing address
432 GROVE PARK LN, LEXINGTON, NC 27295-7378
(336) 764-8140

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
38848
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
095185
NURSING LICENCE
NC
05
8050219
NC
Enumeration date
12/13/2005
Last updated
09/12/2017
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