Provider Demographics
NPI:1629666771
Name:GRIFFIN, DONNELL
Entity Type:Individual
Prefix:
First Name:DONNELL
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19210 KILDEER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-2764
Mailing Address - Country:US
Mailing Address - Phone:216-543-0906
Mailing Address - Fax:216-404-1077
Practice Address - Street 1:19210 KILDEER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-2764
Practice Address - Country:US
Practice Address - Phone:216-543-0906
Practice Address - Fax:216-404-1077
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program