SAMUEL LEROY GRAHAM


Address: 14115 Fred and Al Key Rd, Kiln, MS 39556-8060
Phone: 2284661035

SAMUEL LEROY GRAHAM (NPI# 1932360815) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1932360815
Entity Type Individual
Full Name SAMUEL LEROY GRAHAM
Practice Address 14115 Fred and Al Key Rd
Kiln
MS 39556-8060
Practice Telephone 2284661035
Practice Fax Number 2284668962
Mailing Telephone 2284661035
Mailing Fax Number 2284668962
Enumeration Date 2008-06-23
Last Update Date 2011-03-16
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 286500000X Military Hospital Hospitals
Y 1710I1002X Military Health Care Provider
Specialization: Independent Duty Corpsman
Other Service Providers

Other Providers SAMUEL GRAHAM

NPI Name Taxonomy Address Enumeration
1043376148 Samuel Lyle Graham IIi Internal Medicine 1900 Lonlipman Ct, Louisville, KY 40207-1732 2006-12-31
1730181447 Samuel Lee Graham Psychologist 1000 73rd St, Windsor Heights, IA 50311-1321 2005-08-12

Office Location

Street Address 14115 FRED AND AL KEY RD
City KILN
State MS
Zip Code 39556-8060

Providers in the same location

NPI Name Taxonomy Address Enumeration
1144592841 Brandon Wade Saksa Emergency Medical Technician, Basic 14115 Fred and Al Key Rd, Kiln, MS 39556-8060 2012-01-27

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1003167529 Hancock Medical Health Services, Inc. Nurse Practitioner 6122 Cuevas Town Road, Kiln, MS 39556 2012-09-24
1568713071 Hancock Medical Health Services Nurse Practitioner 4221 Kiln - Delisle Rd., Kiln, MS 39556 2012-09-24
1548511066 Hancock Medical Health Services, Inc. Nurse Practitioner 7070 Stennis Airport Dr., Kiln, MS 39556 2012-09-24
1356692875 Hancock Medical Health Services, Inc. Nurse Practitioner 7084 Stennis Airport Dr., Kiln, MS 39556 2012-09-24
1205955283 Dana Hal Jones Dentist 17094 Hwy 603, Kiln, MS 39556 2007-03-28
1447549761 Kiln Dental Center LLC Dentist 17094 Hwy 603, Kiln, MS 39556 2011-04-07
1952420937 Martin Macrae Murphree Dentist 17094 Hwy 603, Kiln, MS 39556 2007-03-28
1922338037 Cynthia Lee Dedeaux Specialist/Technologist 21271 Lawrence Ladner Rd, Kiln, MS 39556-6490 2010-01-12
1861920407 Micah A Ladner Fnp-c LLC Nurse Practitioner 22549 Fenton Dedeaux Rd, Kiln, MS 39556-6576 2017-05-26
1417134230 Bridget Ann Pendley Licensed Practical Nurse 22463 Fenton Dedeaux Rd, Kiln, MS 39556-6578 2008-01-23
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Taxonomy Information

Taxonomy Code 1710I1002X
Grouping Other Service Providers
Classification Military Health Care Provider
Specialization Independent Duty Corpsman

Taxonomy Definition

A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals.
Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new]

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1043747553 Rowdy Pameticky Military Health Care Provider 952 Poni Pl, Diamondhead, MS 39525-4135 2017-05-15
1528515046 Nicolas Riley Military Health Care Provider 5501 Marvin Shields Blvd., Gulfport, MS 39501-5007 2016-09-01
1235519984 Bradley Craig Wilson Military Health Care Provider 2807 Montclair Ave, Pascagoula, MS 39567-5287 2015-06-08
1477932200 Michael Alexander Boartfield Military Health Care Provider 4033a Mallard Cv, Gulfport, MS 39501-2833 2015-05-26
1336536531 Jeffrey Alexander Leemauk Military Health Care Provider 4010a Blue Heron Way, Gulfport, MS 39501-2815 2015-04-25
1770907412 Matthew Coleman Military Health Care Provider Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 2014-02-18
1427316041 Jeremiah John Baldwin Military Health Care Provider 5303 Marvin Shields Blvd, Gulfport, MS 39501-9013 2012-05-02
1215232830 Jessica E Shores Military Health Care Provider 1000 Access Rd Bldg 2026, Pascagoula, MS 39567 2011-01-12
1124341763 Trevor James Trout Military Health Care Provider 2603 Lower Gainesville Rd, Stennis Space Center, MS 39529-0001 2010-03-10
1245563162 Jenesia Arielle Dillow Ordonia Military Health Care Provider 3158b Holloway Dr, Gulfport, MS 39501-9030 2009-09-10
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Competitor

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City KILN
Zip Code 39556

Improve Information

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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