Provider Demographics
NPI:1053728535
Name:GRAHAM, ADAM (ATC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 N PEACHTREE RD ES RM 114
Mailing Address - Street 2:BOX 5102
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38505-0001
Mailing Address - Country:US
Mailing Address - Phone:931-372-3968
Mailing Address - Fax:931-372-3964
Practice Address - Street 1:1160 N PEACHTREE RD ES RM 114
Practice Address - Street 2:BOX 5102
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38505-0001
Practice Address - Country:US
Practice Address - Phone:931-372-3968
Practice Address - Fax:931-372-3964
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT00000014872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer