Provider Demographics
NPI:1467851220
Name:GRIFFIN, SUSAN (RD, LD, CDE)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 31ST ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1107
Mailing Address - Country:US
Mailing Address - Phone:205-801-8252
Mailing Address - Fax:
Practice Address - Street 1:1021 31ST ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1107
Practice Address - Country:US
Practice Address - Phone:205-801-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2334133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered