Provider Demographics
NPI:1043440381
Name:GRIFFIN, NOLAN JAY (ATC)
Entity Type:Individual
Prefix:MR
First Name:NOLAN
Middle Name:JAY
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 S STRAITS HWY
Mailing Address - Street 2:P.O. BOX 829
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749-5137
Mailing Address - Country:US
Mailing Address - Phone:231-238-4090
Mailing Address - Fax:231-333-3122
Practice Address - Street 1:3412 S STRAITS HWY
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-5137
Practice Address - Country:US
Practice Address - Phone:231-238-4090
Practice Address - Fax:231-333-3122
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer