Provider Demographics
NPI:1629362421
Name:MCGRIFF, LASHONDA JESSICA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LASHONDA
Middle Name:JESSICA
Last Name:MCGRIFF
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-2038
Mailing Address - Country:US
Mailing Address - Phone:904-210-4022
Mailing Address - Fax:
Practice Address - Street 1:4111 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-2038
Practice Address - Country:US
Practice Address - Phone:904-210-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA28203172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker