Provider Demographics
NPI:1437514262
Name:GRIFFIN FAMILY MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:GRIFFIN FAMILY MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:601-854-8002
Mailing Address - Street 1:PO BOX 926
Mailing Address - Street 2:
Mailing Address - City:PELAHATCHIE
Mailing Address - State:MS
Mailing Address - Zip Code:39145-0926
Mailing Address - Country:US
Mailing Address - Phone:601-854-8002
Mailing Address - Fax:601-854-7333
Practice Address - Street 1:507 HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:PELAHATCHIE
Practice Address - State:MS
Practice Address - Zip Code:39145-2786
Practice Address - Country:US
Practice Address - Phone:601-854-8002
Practice Address - Fax:601-854-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR851997363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty