Provider Demographics
NPI:1093856601
Name:GRIFFIN, PHILLIP TALMADGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:TALMADGE
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-4828
Mailing Address - Country:US
Mailing Address - Phone:504-864-1343
Mailing Address - Fax:504-894-7290
Practice Address - Street 1:3450 CHESTNUT ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2443
Practice Address - Country:US
Practice Address - Phone:504-412-1580
Practice Address - Fax:504-412-1530
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA292103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1963933Medicaid
LA1963933Medicaid
R15380Medicare UPIN
LA56143Medicare PIN