Provider Demographics
NPI:1326215120
Name:GRIFFIN, LESLIE C (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:C
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11565
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37401-2565
Mailing Address - Country:US
Mailing Address - Phone:423-778-3274
Mailing Address - Fax:423-778-2255
Practice Address - Street 1:60 ERLANGER SOUTH DRIVE
Practice Address - Street 2:ERLANGER MEDICAL CENTER
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-3179
Practice Address - Country:US
Practice Address - Phone:706-937-9292
Practice Address - Fax:706-937-7207
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN47586207Q00000X
GA066297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine