Provider Demographics
NPI:1508946757
Name:GRIFFIN, BRIAN CHRISTOPHER (PA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3721
Mailing Address - Country:US
Mailing Address - Phone:336-306-0344
Mailing Address - Fax:
Practice Address - Street 1:107 W MEDICAL PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6851
Practice Address - Country:US
Practice Address - Phone:336-713-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01892363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant