Provider Demographics
NPI:1295401545
Name:GRIFFIN, JAMES FORREST
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FORREST
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 NC HIGHWAY 42 N STE B
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-7968
Mailing Address - Country:US
Mailing Address - Phone:336-625-2560
Mailing Address - Fax:336-625-3152
Practice Address - Street 1:197 NC HIGHWAY 42 N STE B
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-7968
Practice Address - Country:US
Practice Address - Phone:336-625-2560
Practice Address - Fax:336-625-3152
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC0010-12987363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-12987OtherSTATE LICENSE