Provider Demographics
NPI:1891703054
Name:GRIFFITH, HENRY RANDALL (PHD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:RANDALL
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3438 CHAPEL HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-6081
Mailing Address - Country:US
Mailing Address - Phone:205-948-7183
Mailing Address - Fax:205-719-4233
Practice Address - Street 1:400 VESTAVIA PKWY STE 130
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-3750
Practice Address - Country:US
Practice Address - Phone:205-823-2373
Practice Address - Fax:205-823-2378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1222103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554327Medicaid
ALP00226576OtherRAILROAD MEDICARE
AL051519003OtherBLUE CROSS
AL051554327Medicaid