Provider Demographics
NPI:1346406592
Name:GRIFFITH-SUMPTER, COURTNEY (PHYSICIANS ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:GRIFFITH-SUMPTER
Suffix:
Gender:F
Credentials:PHYSICIANS ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2324
Mailing Address - Country:US
Mailing Address - Phone:231-348-2828
Mailing Address - Fax:231-348-9609
Practice Address - Street 1:116 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2324
Practice Address - Country:US
Practice Address - Phone:231-348-2828
Practice Address - Fax:231-348-9609
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002527363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical