Provider Demographics
NPI:1083698096
Name:GRIFFIN, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:119 AMBULANCE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:
Practice Address - Street 1:157 CLINIC AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4413
Practice Address - Country:US
Practice Address - Phone:770-834-3336
Practice Address - Fax:770-832-2136
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA45232208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5061659OtherAETNA
GA020043265OtherRAILROAD MEDICARE
GA30117A005OtherCHAMPUS
GA00794989AMedicaid
GA727923OtherBLUE CROSS
GA020043265OtherRAILROAD MEDICARE
GAG68481Medicare UPIN