Provider Demographics
NPI:1659311702
Name:GRIFFIN, CHAD A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:A
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 SEWELL DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:TN
Mailing Address - Zip Code:38583-1223
Mailing Address - Country:US
Mailing Address - Phone:931-739-3000
Mailing Address - Fax:931-739-3013
Practice Address - Street 1:433 SEWELL DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1223
Practice Address - Country:US
Practice Address - Phone:931-739-3000
Practice Address - Fax:931-739-3013
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000028253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3852925Medicaid
TNG64102Medicare UPIN
TN3852925Medicaid