Provider Demographics
NPI:1255378816
Name:GRAYDON, WILLIAM MICHAEL (CRNA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MICHAEL
Last Name:GRAYDON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:WILLIAM
Other - Middle Name:MICHAEL
Other - Last Name:GRAYDON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:2151 OLD ROCKY RIDGE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-7235
Mailing Address - Country:US
Mailing Address - Phone:205-989-1080
Mailing Address - Fax:205-989-1087
Practice Address - Street 1:2010 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6804
Practice Address - Country:US
Practice Address - Phone:205-989-1080
Practice Address - Fax:205-989-1087
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY42181367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered