Provider Demographics
NPI:1427088921
Name:GRILLS, LAURA HOLCOMB (CRNA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:HOLCOMB
Last Name:GRILLS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:R
Other - Last Name:HOLCOMB
Other - Suffix:
Other - Last Name Type:Former 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 1:2720 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3408
Practice Address - Country:US
Practice Address - Phone:205-989-1080
Practice Address - Fax:205-989-1087
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-046106367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL430057128OtherMEDICARE RAILROAD
AL000095020Medicaid
AL51095020HOLMedicare ID - Type Unspecified
AL000095020Medicaid