Provider Demographics
NPI:1477861193
Name:GRIFFIN, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
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 1:3409 BLOOMFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31206-3707
Mailing Address - Country:US
Mailing Address - Phone:478-785-1552
Mailing Address - Fax:478-785-1552
Practice Address - Street 1:3409 BLOOMFIELD DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31206-3707
Practice Address - Country:US
Practice Address - Phone:478-785-1552
Practice Address - Fax:478-785-1552
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA262360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA27-2984400Medicare PIN