Individual provider Active NPI

Krystle Graham, DO

  • Psychiatry Physician
  • Charlotte, NC
National Provider Identifier
1225268949
Registry record updated Mar 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
2016-01099 Issued in NC
Practice address
501 Billingsley Rd
Ste B
Charlotte, NC 28211-1009
Phone
(704) 444-2400
NPI assigned
Jul 15, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 2016-01099 NC Primary

Addresses

Primary practice location

501 Billingsley Rd
Ste B
Charlotte, NC 28211-1009

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Other practice location 1

16740 Davidson Concord Rd
Davidson, NC 28036-8746
Phone (704) 444-2400

Other practice location 2

706 W King St
Kings Mountain, NC 28086-2708
Phone (980) 487-5470

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, NC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121024000484 GA Practitioner - Psychiatry 4880844067 Reassigns benefits to 2 organizations
I20160801000368 NC Practitioner - Psychiatry 4880844067 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Lake Erie College of Osteopathic Medicine, Erie, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gateway Community Service BoardGroup PAC ID 3173510237, 42 clinicians

Practice addresses (Care Compare)

1113 Oglethorpe Hwy
Hinesville, GA 31313-1200
Phone (912) 280-7023

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Medical Center CurrentSince Jul 1, 2016 Accepting new patients
Carolinas Medical Center Current Accepting new patients
Au Medical Associates Inc CurrentSince May 7, 2013 Accepting new patients
Gateway Behavioral Health Services CurrentSince Apr 13, 2020 Accepting new patients
Au Medical Associates Inc CurrentSince May 7, 2013 Accepting new patients
Gateway Community Service Board CurrentSince Apr 13, 2020 Accepting new patients
Carolinas Medical Center CurrentSince Jul 1, 2016 Accepting new patients

Locations

1499 Walton Way
Augusta, GA 30901
Phone (706) 721-0413

1120 15th St
Augusta, GA 30912
Phone (706) 721-3873

700 Coastal Village Dr
Brunswick, GA 31520
Phone (912) 554-8400

1113 E Oglethorpe Hwy
Hinesville, GA 31313
Phone (912) 280-7023

4451 Paulsen St
Savannah, GA 31405
Phone (912) 350-7500

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

501 Billingsley Rd
Ste B
Charlotte, NC 28211
Phone (704) 444-2400

501 Billingsley Rd
Charlotte, NC 28211
Phone (704) 358-2700

16740 Davidson Concord Rd
Davidson, NC 28036
Phone (704) 444-2400

706 W King St
Kings Mtn, NC 28086
Phone (704) 730-5108

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1247616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583107200000",
    "number": "1225268949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 BILLINGSLEY RD",
            "address_2": "STE B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282111009",
            "telephone_number": "704-444-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16740 Davidson Concord Rd",
            "address_purpose": "LOCATION",
            "city": "Davidson",
            "state": "NC",
            "postal_code": "280368746",
            "country_code": "US",
            "telephone_number": "704-444-2400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "706 W King St",
            "address_purpose": "LOCATION",
            "city": "Kings Mountain",
            "state": "NC",
            "postal_code": "280862708",
            "country_code": "US",
            "telephone_number": "980-487-5470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "KRYSTLE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-15",
        "last_updated": "2020-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2016-01099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.