Provider Demographics
NPI:1710956214
Name:GRIFFITH, RAYMOND WILLIAM (CRNA)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:WILLIAM
Last Name:GRIFFITH
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 1:4488 RIDGE PINE DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4499
Mailing Address - Country:US
Mailing Address - Phone:706-854-0751
Mailing Address - Fax:
Practice Address - Street 1:915 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4115
Practice Address - Country:US
Practice Address - Phone:706-738-4925
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN108466 CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered