Provider Demographics
NPI:1629358353
Name:WILLIAMS GIFFIN, MARTHA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:WILLIAMS GIFFIN
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 1:7833 TOWNSHIP ROAD 331 SE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:OH
Mailing Address - Zip Code:43730-9505
Mailing Address - Country:US
Mailing Address - Phone:740-347-4647
Mailing Address - Fax:
Practice Address - Street 1:7833 TOWNSHIP ROAD 331 SE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:OH
Practice Address - Zip Code:43730-9505
Practice Address - Country:US
Practice Address - Phone:740-347-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2881967374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2881967Medicaid