Provider Demographics
NPI:1154540359
Name:GRAVES, EMILY TAYLOR (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:TAYLOR
Last Name:GRAVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6363 POPLAR AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-4831
Mailing Address - Country:US
Mailing Address - Phone:901-692-5780
Mailing Address - Fax:901-592-6789
Practice Address - Street 1:2606 S. LAMAR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5302
Practice Address - Country:US
Practice Address - Phone:662-234-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23034207W00000X
TN47117207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1524259Medicaid