Provider Demographics
NPI:1609941665
Name:GRIFFITH, GEORGE W (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:W
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:W
Other - Last Name:GRIFFITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1405
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-1405
Mailing Address - Country:US
Mailing Address - Phone:606-256-2961
Mailing Address - Fax:606-256-3562
Practice Address - Street 1:140 NEWCOMB AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-2725
Practice Address - Country:US
Practice Address - Phone:606-256-2961
Practice Address - Fax:606-256-3562
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1342894OtherCOVENTRY CARES
KY10006897OtherKY COOPERATIVE
KY64173776Medicaid
KY596965OtherWELLCARE
KY000000790871OtherANTHEM
KY10006897OtherKY COOPERATIVE
KY183476Medicare PIN