Provider Demographics
NPI:1003484932
Name:GRIFFIN, ANNETTE S
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:S
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:GIFFORD
Mailing Address - State:SC
Mailing Address - Zip Code:29923-0212
Mailing Address - Country:US
Mailing Address - Phone:803-842-5516
Mailing Address - Fax:
Practice Address - Street 1:140 WALTERS PLACE
Practice Address - Street 2:
Practice Address - City:GIFFORD
Practice Address - State:SC
Practice Address - Zip Code:29923-2992
Practice Address - Country:US
Practice Address - Phone:803-842-5516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency