Individual
SAMUEL LEROY GRAHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14115 FRED AND AL KEY RD, KILN, MS 39556-8060
(228) 466-1035
(228) 466-8962
Mailing address
14115 FRED AND AL KEY RD, KILN, MS 39556-8060
(228) 466-1035
(228) 466-8962
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
286500000X
Military Hospital
—
—
Other
Enumeration date
06/23/2008
Last updated
03/16/2011
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