Provider Demographics
NPI:1558396358
Name:HIXON-GRIFFIN, JAMIE T (MD)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:T
Last Name:HIXON-GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:T
Other - Last Name:HIXON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3495 PIEDMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1717
Mailing Address - Country:US
Mailing Address - Phone:404-365-0966
Mailing Address - Fax:
Practice Address - Street 1:526 BOLL WEEVIL CIR
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-4012
Practice Address - Country:US
Practice Address - Phone:334-308-1166
Practice Address - Fax:334-308-1019
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26574208000000X
GA062041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009938874Medicaid
AL140475Medicaid
MS09134018Medicaid
AL051535996Medicare ID - Type Unspecified
MS09134018Medicaid
I63011Medicare UPIN