Provider Demographics
NPI:1679696793
Name:ROBERTS, GRAHAM LEE (MD)
Entity type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:LEE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1878 SWYNFORD LN
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-7858
Mailing Address - Country:US
Mailing Address - Phone:901-221-8554
Mailing Address - Fax:731-644-8488
Practice Address - Street 1:301 TYSON AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4544
Practice Address - Country:US
Practice Address - Phone:731-644-8379
Practice Address - Fax:731-644-8488
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN397542085R0202X
AZ373532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology