Provider Demographics
NPI:1407152507
Name:GRIFFIN, GERALD LEROY (RPH)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:LEROY
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2721 BONDS LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3175
Mailing Address - Country:US
Mailing Address - Phone:678-520-4985
Mailing Address - Fax:
Practice Address - Street 1:520 BOULEVARD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315
Practice Address - Country:US
Practice Address - Phone:404-624-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0119171835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy