Provider Demographics
NPI:1215095336
Name:GRAHAM, JERRY M (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:M
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9668 MADISON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-9126
Mailing Address - Country:US
Mailing Address - Phone:256-461-7482
Mailing Address - Fax:256-461-7427
Practice Address - Street 1:9668 MADISON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9126
Practice Address - Country:US
Practice Address - Phone:256-461-7482
Practice Address - Fax:256-461-7427
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2019-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL7312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC70095Medicare UPIN