Provider Demographics
NPI:1558523779
Name:GRIFFIN, BESSALIEA ATHALIA
Entity Type:Individual
Prefix:
First Name:BESSALIEA
Middle Name:ATHALIA
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 N BRIGHTLEAF BLVD
Mailing Address - Street 2:SUITE 1610
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4407
Mailing Address - Country:US
Mailing Address - Phone:919-934-0711
Mailing Address - Fax:919-934-0023
Practice Address - Street 1:514 N BRIGHTLEAF BLVD
Practice Address - Street 2:SUITE 1610
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4407
Practice Address - Country:US
Practice Address - Phone:919-934-0711
Practice Address - Fax:919-934-0023
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC546213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC14420281Medicare PIN