Provider Demographics
NPI:1427888288
Name:GRAHAM, ASHTON
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 KIESWETTER RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8674
Mailing Address - Country:US
Mailing Address - Phone:419-276-5530
Mailing Address - Fax:
Practice Address - Street 1:1125 KIESWETTER RD
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8674
Practice Address - Country:US
Practice Address - Phone:419-276-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver