Provider Demographics
NPI:1477194587
Name:GRIFFIN, VANESSA SUN
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:SUN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 GLENRIDGE DR APT 222
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1331
Mailing Address - Country:US
Mailing Address - Phone:828-279-1252
Mailing Address - Fax:
Practice Address - Street 1:227 SANDY SPRINGS PL STE 378
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5916
Practice Address - Country:US
Practice Address - Phone:770-212-2242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN210136363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily