Individual
LARRY G GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5301 VIRGINIA WAY STE 300, BRENTWOOD, TN 37027-7542
(615) 221-4474
(615) 234-3774
Mailing address
5301 VIRGINIA WAY STE 300, BRENTWOOD, TN 37027-7542
(615) 221-4474
(615) 234-3774
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
24891
KY
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
9225
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000005006002
TLC TENNCARE
TN
01
—
119586
UNISON TENNCARE
TN
01
—
231705
BLUE CROSS
VA
01
—
3025074
BLUE CROSS
TN
05
—
3040511
—
TN
05
—
64777063
—
KY
05
—
89063F6
—
NC
Enumeration date
09/25/2006
Last updated
07/09/2007
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