Provider Demographics
NPI:1275250797
Name:GRIFFIN, MEGAN CHASITY (PRSS)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:CHASITY
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1307
Mailing Address - Country:US
Mailing Address - Phone:304-872-9645
Mailing Address - Fax:304-872-9643
Practice Address - Street 1:603 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1307
Practice Address - Country:US
Practice Address - Phone:304-872-9645
Practice Address - Fax:304-872-9643
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19-916175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist