Provider Demographics
NPI:1124882709
Name:GRIFFITH, ANNJEANETTE DAWN (HIS 2101002759)
Entity type:Individual
Prefix:
First Name:ANNJEANETTE
Middle Name:DAWN
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:HIS 2101002759
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4903 PLANK RD STE 101B
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6367
Mailing Address - Country:US
Mailing Address - Phone:540-785-4676
Mailing Address - Fax:
Practice Address - Street 1:4903 PLANK RD STE 101B101
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6938
Practice Address - Country:US
Practice Address - Phone:540-785-4676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002759237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist