Provider Demographics
NPI:1760435515
Name:GRIFFITH, JOHN G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:28 MIDWAY ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1706
Mailing Address - Country:US
Mailing Address - Phone:423-573-8100
Mailing Address - Fax:423-573-8102
Practice Address - Street 1:28 MIDWAY ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1706
Practice Address - Country:US
Practice Address - Phone:423-573-8100
Practice Address - Fax:423-573-8102
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25475208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007500319Medicaid
TN3044711OtherBLUECROSS BLUESHIELD
0213340004OtherDMERC
TN3084126Medicaid
VA086649OtherANTHEM
62086999804OtherJOHN DEERE
340011816Medicare ID - Type UnspecifiedRAILROAD
TN3044711OtherBLUECROSS BLUESHIELD
62086999804OtherJOHN DEERE