Provider Demographics
NPI:1558688416
Name:GRIFFIN, LEPERCIVAL (MD)
Entity Type:Individual
Prefix:
First Name:LEPERCIVAL
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321359
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-1359
Mailing Address - Country:US
Mailing Address - Phone:601-936-1395
Mailing Address - Fax:
Practice Address - Street 1:1860 CHADWICK DR STE 351
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3472
Practice Address - Country:US
Practice Address - Phone:601-376-1288
Practice Address - Fax:601-376-1293
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07754391Medicaid