Provider Demographics
NPI:1356361034
Name:GRIFFIN, KIMBERLY ANNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 RIO VISTA DR
Mailing Address - Street 2:P.O.BOX 2025
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-5147
Mailing Address - Country:US
Mailing Address - Phone:706-271-6974
Mailing Address - Fax:706-876-1563
Practice Address - Street 1:2100 S HAMILTON ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-5349
Practice Address - Country:US
Practice Address - Phone:706-272-1415
Practice Address - Fax:706-272-1422
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2396363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical