Individual
CORNELL GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2500 N STATE ST, DEPARTMENT OF ANESTHESIA, JACKSON, MS 39216-4500
(601) 984-5952
(601) 984-5939
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5952
(601) 984-5939
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
2723
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
R880851
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09739086
—
MS
05
—
2406230
—
LA
01
—
P01590551
RAILROAD MEDICARE
MS
Enumeration date
02/05/2014
Last updated
03/10/2016
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