Provider Demographics
NPI:1689404766
Name:GRAHAM, RICHARD (CPED)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 LAKE MURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8626
Mailing Address - Country:US
Mailing Address - Phone:803-269-3990
Mailing Address - Fax:803-407-9195
Practice Address - Street 1:1671 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8626
Practice Address - Country:US
Practice Address - Phone:803-269-3546
Practice Address - Fax:803-407-9195
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCPED0707224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist