Provider Demographics
NPI:1023693561
Name:GRAHAM, NATACHA (CPC, CFM)
Entity type:Individual
Prefix:
First Name:NATACHA
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:CPC, CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 COURT ST
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-2709
Mailing Address - Country:US
Mailing Address - Phone:334-478-5090
Mailing Address - Fax:844-826-8064
Practice Address - Street 1:102 COURT ST
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-2709
Practice Address - Country:US
Practice Address - Phone:334-478-5090
Practice Address - Fax:844-826-8064
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL402224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1023569803OtherDME