Provider Demographics
NPI:1508278110
Name:GRIFFIN, LETHERRON
Entity Type:Individual
Prefix:MR
First Name:LETHERRON
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6527
Mailing Address - Country:US
Mailing Address - Phone:586-563-7705
Mailing Address - Fax:
Practice Address - Street 1:2718 ELECTRIC AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6527
Practice Address - Country:US
Practice Address - Phone:586-563-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-30
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant