Provider Demographics
NPI:1689859340
Name:MALINDA GRAHAM AND ASSOCIATES
Entity type:Organization
Organization Name:MALINDA GRAHAM AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MALINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-977-6523
Mailing Address - Street 1:1518 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-9439
Mailing Address - Country:US
Mailing Address - Phone:912-877-7928
Mailing Address - Fax:
Practice Address - Street 1:1518 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-9439
Practice Address - Country:US
Practice Address - Phone:912-877-7928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health