Provider Demographics
NPI:1043318959
Name:GRIFFIN, DAVID SHAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:SHAYNE
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 BEACON CV
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5892
Mailing Address - Country:US
Mailing Address - Phone:770-712-8560
Mailing Address - Fax:
Practice Address - Street 1:2705 AIRPORT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-9201
Practice Address - Country:US
Practice Address - Phone:706-278-4337
Practice Address - Fax:706-278-1854
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist