Provider Demographics
NPI:1225668742
Name:GRIFFIN, ADA MICHELLE
Entity Type:Individual
Prefix:
First Name:ADA
Middle Name:MICHELLE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 CAHABA LANDINGS RD
Mailing Address - Street 2:
Mailing Address - City:IRONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35210-4003
Mailing Address - Country:US
Mailing Address - Phone:205-441-0322
Mailing Address - Fax:
Practice Address - Street 1:478 CAHABA LANDINGS RD
Practice Address - Street 2:
Practice Address - City:IRONDALE
Practice Address - State:AL
Practice Address - Zip Code:35210-4003
Practice Address - Country:US
Practice Address - Phone:205-441-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS12685390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program