Individual
MR. JUSTIN ROBERT GRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
5 RICHLAND MEDICAL PARK DR, COLUMBIA, SC 29203-6863
(803) 434-7000
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
215793
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
17748
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN2207
—
SC
Enumeration date
01/25/2012
Last updated
01/27/2022
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