Provider Demographics
NPI:1598560500
Name:GRAHAM, JIMMIE III
Entity type:Individual
Prefix:MR
First Name:JIMMIE
Middle Name:
Last Name:GRAHAM
Suffix:III
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 1:129 DOBBS CO COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-9106
Mailing Address - Country:US
Mailing Address - Phone:252-521-9490
Mailing Address - Fax:
Practice Address - Street 1:129 DOBBS CO COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:NC
Practice Address - Zip Code:28551-9106
Practice Address - Country:US
Practice Address - Phone:252-521-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)