Provider Demographics
NPI:1003907783
Name:GRIFFIN, PATRICIA C (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:C
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
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 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6917
Practice Address - Fax:864-560-6017
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC171232085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0371Medicaid
SC171234Medicaid
NC790568AMedicaid
NC890124VMedicaid
SCF100537652OtherMEDICARE PIN
SC920002586OtherRAILROAD MEDICARE
SCGP0371Medicaid
NC890124VMedicaid