Provider Demographics
NPI:1518695279
Name:GRIFFIN, JAMIE (RDN, LDN, PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RDN, LDN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5396 41ST INF REGIMENT STREET
Mailing Address - Street 2:
Mailing Address - City:FORT MOORE
Mailing Address - State:GA
Mailing Address - Zip Code:31905
Mailing Address - Country:US
Mailing Address - Phone:706-366-7524
Mailing Address - Fax:
Practice Address - Street 1:5396 41ST INF REGIMENT ST
Practice Address - Street 2:
Practice Address - City:FORT MOORE
Practice Address - State:GA
Practice Address - Zip Code:31905
Practice Address - Country:US
Practice Address - Phone:706-366-7524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005807133V00000X
AL5114133V00000X
1024069133V00000X
133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered