Provider Demographics
NPI:1023553872
Name:GRIFFITH, JACOB RYAN
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:RYAN
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9125 CROSS PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4563
Mailing Address - Country:US
Mailing Address - Phone:865-632-5900
Mailing Address - Fax:
Practice Address - Street 1:9125 CROSS PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4563
Practice Address - Country:US
Practice Address - Phone:865-632-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ030515Medicaid