Provider Demographics
NPI:1033237540
Name:GRIGGS, JONATHAN P (DMD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:P
Last Name:GRIGGS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4128 ARKWRIGHT RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1707
Mailing Address - Country:US
Mailing Address - Phone:478-471-0404
Mailing Address - Fax:478-471-9162
Practice Address - Street 1:4128 ARKWRIGHT RD
Practice Address - Street 2:SUITE A
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1707
Practice Address - Country:US
Practice Address - Phone:478-471-0404
Practice Address - Fax:478-471-9162
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist