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MR. MICHAEL TERRELL GRISSOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNP

Contact information

Practice address
8375 HIGHWAY 72 W, MADISON, AL 35758-9573
(256) 265-2012
Mailing address
303 KIMBERLY AVE, MUSCLE SHOALS, AL 35661-3768
(256) 394-3612

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
1-131578
AL
363LG0600X
Gerontology Nurse Practitioner
1-131578
AL
363LP2300X
Primary Care Nurse Practitioner
1-131578
AL

Other

Enumeration date
09/15/2015
Last updated
09/15/2015
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