Basic Information
| Provider Information | |||||||||
| NPI: | 1871749572 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | LEONA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 ROSS CLARK CIR | ||||||||
| Address2: | SOUTHEAST ALABAMA MEDICAL CENTER | ||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363013022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347944582 | ||||||||
| FaxNumber: | 3346719877 | ||||||||
| Practice Location | |||||||||
| Address1: | 1865 HONEYSUCKLE RD STE 2 | ||||||||
| Address2: | SOUTHEAST ALABAMA MEDICAL CENTER- ALTACARE | ||||||||
| City: | DOTHAN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 363054287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3347944582 | ||||||||
| FaxNumber: | 3346719877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2008 | ||||||||
| LastUpdateDate: | 02/05/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 33645 | AL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.