Provider Demographics
NPI:1013583053
Name:GRIFFIN, NATHAN KEVIN (AUD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:KEVIN
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 MARS HILL RD STE B
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4886
Mailing Address - Country:US
Mailing Address - Phone:706-549-3111
Mailing Address - Fax:706-549-0488
Practice Address - Street 1:1580 MARS HILL RD STE B
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4886
Practice Address - Country:US
Practice Address - Phone:706-549-3111
Practice Address - Fax:706-549-0488
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004273231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAUD004273OtherGEORGIA AUDIOLOGY LICENSE