Healthcare Provider Details

I. General information

NPI: 1780673459
Provider Name (Legal Business Name): RAYMOND JEFFERY GROOMS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SWEETGUM XING
SAVANNAH GA
31411-2734
US

IV. Provider business mailing address

122 RICE MILL DR
SAVANNAH GA
31419-9073
US

V. Phone/Fax

Practice location:
  • Phone: 912-665-0628
  • Fax:
Mailing address:
  • Phone: 912-921-4719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN093384
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN28204
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: