Provider Demographics
NPI:1306835178
Name:GRIFFIN, DONALD SCOTT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:SCOTT
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 BERNARDIN AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2039
Mailing Address - Country:US
Mailing Address - Phone:803-254-5038
Mailing Address - Fax:803-376-5883
Practice Address - Street 1:1655 BERNARDIN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2039
Practice Address - Country:US
Practice Address - Phone:803-254-5038
Practice Address - Fax:803-376-5883
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCA747363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0340PAMedicaid
SC0340PAMedicaid