Provider Demographics
NPI:1093702557
Name:GRIFFITH, MICHELE Y (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:Y
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6005 GLEN MANOR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-1082
Mailing Address - Country:US
Mailing Address - Phone:980-253-5619
Mailing Address - Fax:888-740-5517
Practice Address - Street 1:8500 ANDREW CARNEGIE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8500
Practice Address - Country:US
Practice Address - Phone:704-988-2572
Practice Address - Fax:704-988-4820
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200401513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901098Medicaid
NCI25510Medicare UPIN
NC8901098Medicaid