Provider Demographics
NPI:1871697086
Name:GROSSELL, JAMES (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GROSSELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1227
Mailing Address - Country:US
Mailing Address - Phone:662-293-2000
Mailing Address - Fax:662-665-0857
Practice Address - Street 1:401 ALCORN DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9072
Practice Address - Country:US
Practice Address - Phone:662-293-2000
Practice Address - Fax:662-665-0857
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR556955367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00019891Medicaid