Provider Demographics
NPI:1275388415
Name:GRIFFIN, WYNTON CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:WYNTON
Middle Name:CHRISTOPHER
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 WESTBANK EXPY STE 400
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-4371
Mailing Address - Country:US
Mailing Address - Phone:504-367-7724
Mailing Address - Fax:504-367-7725
Practice Address - Street 1:1901 WESTBANK EXPY STE 400
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-4371
Practice Address - Country:US
Practice Address - Phone:504-367-7724
Practice Address - Fax:504-367-7725
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15485374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide