Provider Demographics
NPI:1063485068
Name:GRIFFIN, JASON E (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:E
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6698
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31758-6698
Mailing Address - Country:US
Mailing Address - Phone:229-226-5788
Mailing Address - Fax:229-226-2548
Practice Address - Street 1:2621 E PINETREE BLVD
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4840
Practice Address - Country:US
Practice Address - Phone:229-584-4100
Practice Address - Fax:229-584-4152
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000931675AMedicaid
GA001257OtherBC/BS OF GA
GAG76026Medicare UPIN
GAP00207650Medicare ID - Type UnspecifiedRAILROAD MEDICARE
GA001257OtherBC/BS OF GA