Provider Demographics
NPI:1689735029
Name:GIRARD, JULIA GRIFFIN (MD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:GRIFFIN
Last Name:GIRARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:ELIZABETH
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:550 REDMOND RD NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1416
Practice Address - Country:US
Practice Address - Phone:706-233-8516
Practice Address - Fax:706-233-8517
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051323207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000964235AMedicaid
H73854Medicare UPIN
GA07BBSMBMedicare PIN