| Doctor Name: | SAMUEL LEROY GRAHAM |
| NPI Number: | 1932360815 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 14115 Fred And Al Key Rd Kiln, MS - 395568060 |
| Business Phone Number: | 2284661035 |
| Business Fax Number: | 2284668962 |
| Mailing Address: | 14115 Fred And Al Key Rd, KILN |
| State: | MS |
| Postal Code: | 395568060 |
| Phone Number: | 2284661035 |
| Fax Number: | 2284668962 |
| NPI Enumeration Date: | 06/23/2008 |
| NPI Last Update Date: | 03/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 286500000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | Military Hospital |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care facility operated by the Department of Defense. |