Provider Demographics
NPI:1083856082
Name:GRIFFIN, JESSICA P (RD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:P
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E WOOD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3058
Mailing Address - Country:US
Mailing Address - Phone:864-560-7070
Mailing Address - Fax:864-560-7073
Practice Address - Street 1:100 E WOOD ST STE 200
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3058
Practice Address - Country:US
Practice Address - Phone:864-560-7070
Practice Address - Fax:864-560-7073
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003315133V00000X
SC800133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ354467628Medicare PIN