Provider Demographics
NPI:1275421893
Name:GRAVES, MAHAGANY ANTOINETTE
Entity type:Individual
Prefix:
First Name:MAHAGANY
Middle Name:ANTOINETTE
Last Name:GRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAHAGANY
Other - Middle Name:ANTOINETTE
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2515 R ST SE APT 316
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3969
Mailing Address - Country:US
Mailing Address - Phone:240-762-9790
Mailing Address - Fax:
Practice Address - Street 1:1440 ALABAMA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-5051
Practice Address - Country:US
Practice Address - Phone:202-597-4449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant