Provider Demographics
NPI:1245574110
Name:GRIFFITH, JEANA RENEE' (PHD)
Entity type:Individual
Prefix:DR
First Name:JEANA
Middle Name:RENEE'
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6350 LAKE OCONEE PKWY
Mailing Address - Street 2:#110 PMB 56
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642
Mailing Address - Country:US
Mailing Address - Phone:770-771-6330
Mailing Address - Fax:
Practice Address - Street 1:1291 BIG WATER CIR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-3715
Practice Address - Country:US
Practice Address - Phone:770-771-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002334103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical