Provider Demographics
NPI:1083049787
Name:GRIFFITH, BILLY ALLEN JR (CSFA, KCSA)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:ALLEN
Last Name:GRIFFITH
Suffix:JR
Gender:M
Credentials:CSFA, KCSA
Other - Prefix:
Other - First Name:DANE
Other - Middle Name:
Other - Last Name:GRIFFITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSFA, KCSA
Mailing Address - Street 1:835 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2062
Mailing Address - Country:US
Mailing Address - Phone:859-916-5435
Mailing Address - Fax:
Practice Address - Street 1:835 MONROE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2062
Practice Address - Country:US
Practice Address - Phone:513-374-5149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant