Individual
HAROLD J GRISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2520 5TH ST N, COLUMBUS, MS 39705-2008
(662) 244-1000
(662) 327-6004
Mailing address
29 CREAMERY LN, EASTON, MD 21601-3137
(800) 222-1335
(800) 222-1335
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R857989
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04438041
—
MS
01
—
149323637
TRI-CARE
MS
Enumeration date
01/24/2008
Last updated
05/13/2010
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