Provider Demographics
NPI:1942261839
Name:GRIFFITH, JOHN P (PA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609A PINER RD STE 153
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-4201
Mailing Address - Country:US
Mailing Address - Phone:910-742-7816
Mailing Address - Fax:
Practice Address - Street 1:308 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5266
Practice Address - Country:US
Practice Address - Phone:910-346-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00831363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2769332BMedicare PIN
NC2769332HMedicare PIN
NC2769332GMedicare PIN
2769332BMedicare PIN