Provider Demographics
NPI:1205428166
Name:GRIFFITH, MARTY ERWIN (ACNP)
Entity type:Individual
Prefix:
First Name:MARTY
Middle Name:ERWIN
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 ROLLING LINKS BLVD
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-9024
Mailing Address - Country:US
Mailing Address - Phone:865-310-1281
Mailing Address - Fax:
Practice Address - Street 1:1932 ALCOA HWY STE 270
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1537
Practice Address - Country:US
Practice Address - Phone:865-251-4658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000028754363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care