MEDICARE: MATTHEW GRAYSON CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	18866	SC

General Provider Information

NPI Number	:	1700214954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW GRAYSON CRNA

Provider Business Mailing Address
First Line	:	2655 HARRISON RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2530
Country	:	US
Telephone Number	:	336-486-2086
Fax Number	:

Provider Business Practice Location Address
First Line	:	2655 HARRISON RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-2530
Country	:	US
Telephone Number	:	336-486-2086
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2013
Last Update Date	:	03/05/2026

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