Provider Demographics
NPI:1518097815
Name:GRIFFITH, CAMERON S (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:S
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1420 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3107
Mailing Address - Country:US
Mailing Address - Phone:601-264-3937
Mailing Address - Fax:601-264-5930
Practice Address - Street 1:1420 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3107
Practice Address - Country:US
Practice Address - Phone:601-264-3937
Practice Address - Fax:601-264-5930
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59069207W00000X
MS20249207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS512G180038OtherMEDICARE PTAN
MS512G700152OtherGROUP MEDICARE PTAN FOR SOUTHERN EYE PHYSICIAN'S CENTER LLC
MS20249OtherMISSISSIPPI MEDICAL LICENSE
MS512G490003OtherGROUP MEDICARE PTAN FOR SOUTHERN EYE SURGERY CENTER LLC
MS04175796Medicaid
GA59069OtherMEDICAL LICENSE