Provider Demographics
NPI:1801821731
Name:ALESIA W GRIFFIN MD PC
Entity Type:Organization
Organization Name:ALESIA W GRIFFIN MD PC
Other - Org Name:ATLANTIC CARE ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALESIA
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-366-0692
Mailing Address - Street 1:PO BOX 13129
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-0129
Mailing Address - Country:US
Mailing Address - Phone:757-366-0692
Mailing Address - Fax:757-366-9118
Practice Address - Street 1:1413 KEMPSVILLE RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-8134
Practice Address - Country:US
Practice Address - Phone:757-366-0692
Practice Address - Fax:757-366-9118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAY22501Medicare UPIN