Provider Demographics
NPI:1689395139
Name:GRAHAM, JAMES A JR
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:GRAHAM
Suffix:JR
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 1:122 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-5575
Mailing Address - Country:US
Mailing Address - Phone:803-542-0443
Mailing Address - Fax:
Practice Address - Street 1:122 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-5575
Practice Address - Country:US
Practice Address - Phone:803-542-0443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC171WH0202X
171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications