Provider Demographics
NPI:1144279365
Name:GRAHAM, ALMEDA MYERS
Entity type:Individual
Prefix:MS
First Name:ALMEDA
Middle Name:MYERS
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 S FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4364
Mailing Address - Country:US
Mailing Address - Phone:843-472-5234
Mailing Address - Fax:843-492-7418
Practice Address - Street 1:105 S FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4364
Practice Address - Country:US
Practice Address - Phone:843-472-5234
Practice Address - Fax:843-492-7418
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
SC19805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144279365OtherNPI
SCDE2391Medicaid
SCNP4263Medicaid