Provider Demographics
NPI:1043740947
Name:GRIFFITH, BRIAN GENE
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:GENE
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 1:615 GREENE 728 RD
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-8854
Mailing Address - Country:US
Mailing Address - Phone:870-586-8859
Mailing Address - Fax:
Practice Address - Street 1:4601 LINWOOD DR
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-8833
Practice Address - Country:US
Practice Address - Phone:870-215-0388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer