Provider Demographics
NPI:1134297351
Name:COMPREHENSIVE FAMILY MEDICINE
Entity Type:Organization
Organization Name:COMPREHENSIVE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-374-3481
Mailing Address - Street 1:829 PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6757
Mailing Address - Country:US
Mailing Address - Phone:478-374-3481
Mailing Address - Fax:478-374-3310
Practice Address - Street 1:829 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6757
Practice Address - Country:US
Practice Address - Phone:478-374-3481
Practice Address - Fax:478-374-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038140174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF68626Medicare UPIN
GA08BBWNFMedicare ID - Type UnspecifiedMEDICARE