Provider Demographics
NPI:1073792941
Name:GRIFFIN, KENYETTA JOY (LCAS)
Entity Type:Individual
Prefix:
First Name:KENYETTA
Middle Name:JOY
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 REMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5013
Mailing Address - Country:US
Mailing Address - Phone:704-332-9001
Mailing Address - Fax:704-332-0124
Practice Address - Street 1:145 REMOUNT RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5013
Practice Address - Country:US
Practice Address - Phone:704-332-9001
Practice Address - Fax:704-332-0124
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program