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General NPI Number Information
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NPI Number | 1780673459
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Entity Type | Individual
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Provider Name | RAYMOND JEFFERY GROOMS CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 5 SWEETGUM XING
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City | SAVANNAH
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State | GA
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Zip | 31411-2734
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Country | US
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Telephone | 912-665-0628
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Fax |
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Provider Business Mailing Address
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Address Line | 122 RICE MILL DR
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City | SAVANNAH
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State | GA
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Zip | 31419-9073
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Country | US
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Telephone | 912-921-4719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN093384
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APN28204
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License Number State | SC
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