Provider Demographics
NPI:1710743588
Name:GRIFFIN, CHANCEY JENAE (LPN)
Entity Type:Individual
Prefix:
First Name:CHANCEY
Middle Name:JENAE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 RIVER RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-1002
Mailing Address - Country:US
Mailing Address - Phone:470-637-8681
Mailing Address - Fax:
Practice Address - Street 1:600 GREENSFERRY AVE SW APT 1104
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30314-4349
Practice Address - Country:US
Practice Address - Phone:470-637-8681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS333988164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse