Provider Demographics
NPI:1033860911
Name:GORSLINE, GRAHAM JAMES (DNP CRNA)
Entity Type:Individual
Prefix:DR
First Name:GRAHAM
Middle Name:JAMES
Last Name:GORSLINE
Suffix:
Gender:M
Credentials:DNP CRNA
Other - Prefix:
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Mailing Address - Street 1:1343 PEACOCK AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31906-1943
Mailing Address - Country:US
Mailing Address - Phone:607-207-7263
Mailing Address - Fax:
Practice Address - Street 1:6600 VAN AALST BLVD BLDG 9250
Practice Address - Street 2:
Practice Address - City:FORT MOORE
Practice Address - State:GA
Practice Address - Zip Code:31905-2102
Practice Address - Country:US
Practice Address - Phone:762-408-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01166900367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered