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Individual

MRS. SANDRA GRAHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
2246 HIGHWAY 17, LITTLE RIVER, SC 29566-9235
(843) 663-2220
(843) 663-2221
Mailing address
111 DOCTOR CIR, COLUMBIA, SC 29203-6502
(800) 491-0909

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
20847
SC
363LF0000X
Family Nurse Practitioner
Primary
20847
SC
390200000X
Student in an Organized Health Care Education/Training Program
64997
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
30705179
SELECT HEALTH MEDICAID LINE OF BUSINESS
SC
01
4924376
AETNA
SC
01
6425288
UNITED HEALTHCARE
SC
01
7206002
CIGNA
SC
Enumeration date
12/15/2016
Last updated
09/07/2025
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