Provider Demographics
NPI:1689291338
Name:GRANDISON, SHIRLEY (CNA)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:GRANDISON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 E FLORENCE ST
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-6443
Mailing Address - Country:US
Mailing Address - Phone:850-316-5749
Mailing Address - Fax:
Practice Address - Street 1:307 E FLORENCE ST
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-6443
Practice Address - Country:US
Practice Address - Phone:850-316-5749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSA036266OtherMISSISSIPPI HEALTH BOARD