Provider Demographics
NPI:1609002500
Name:GRIFFIN, JENNIFER KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:KATHLEEN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32128 BROKEN BRANCH CIR
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORT
Mailing Address - State:AL
Mailing Address - Zip Code:36527-6000
Mailing Address - Country:US
Mailing Address - Phone:251-626-6757
Mailing Address - Fax:
Practice Address - Street 1:32128 BROKEN BRANCH CIR
Practice Address - Street 2:
Practice Address - City:SPANISH FORT
Practice Address - State:AL
Practice Address - Zip Code:36527-6000
Practice Address - Country:US
Practice Address - Phone:251-626-6757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21889207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02682506Medicaid
MS302I081179Medicare PIN