Provider Demographics
NPI:1689758138
Name:GRIFFITH, ROBERT CARL III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CARL
Last Name:GRIFFITH
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6311 KINGSTON PIKE
Mailing Address - Street 2:SUITE 22E
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919
Mailing Address - Country:US
Mailing Address - Phone:865-588-1361
Mailing Address - Fax:865-584-7087
Practice Address - Street 1:6311 KINGSTON PIKE
Practice Address - Street 2:SUITE 22E
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-588-1361
Practice Address - Fax:865-584-7087
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD10201207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3164169Medicare PIN
B59301Medicare UPIN