Damon Graham Jr

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW005767 Issued in GA

Legal business name

DAMON GRAHAM JR

Practice address

635 Myron Hart Rd
Coolidge, GA 31738-2143

Phone

(229) 224-0655

Fax

(229) 941-5865

NPI assigned

Jul 30, 2018

Organization subpart

No

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

Authorized official

Name

Damon Graham Jr., LCSW, MPA, MS

Title

Ceo

Phone

(229) 224-0655

Specialties & licenses 1

Addresses

Other names 1

• Magella Behavioral Health Consulting Doing business as

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

{
    "created_epoch": "1532908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552089600000",
    "number": "1780162008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 MYRON HART RD",
            "city": "COOLIDGE",
            "state": "GA",
            "postal_code": "317382143",
            "telephone_number": "229-224-0655",
            "fax_number": "229-941-5865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 MYRON HART RD",
            "city": "COOLIDGE",
            "state": "GA",
            "postal_code": "317382143",
            "telephone_number": "229-224-0655",
            "fax_number": "229-941-5865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAMON GRAHAM JR",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-30",
        "last_updated": "2019-03-09",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "DAMON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-224-0655",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "LCSW, MPA, MS"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW005767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Magella Behavioral Health Consulting",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joshua D Flounoy
• Patricia Ann Flounoy, OWNER
• Amanda Gandy, MSW
• Damon Graham Jr., LCSW
• Sylvia Holmes

• All providers in Coolidge, GA
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.