Provider Demographics
NPI:1548596042
Name:GRIFFITH, MARY JANE (MSN, RN, GNP-BC, ACH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MSN, RN, GNP-BC, ACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 DOUG WHITE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4181
Mailing Address - Country:US
Mailing Address - Phone:843-236-1950
Mailing Address - Fax:843-236-1952
Practice Address - Street 1:920 DOUG WHITE DR STE 250
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4181
Practice Address - Country:US
Practice Address - Phone:843-236-1950
Practice Address - Fax:843-236-1952
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17481363LG0600X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1548596042OtherPENDING
SCNP1872Medicaid