Provider Demographics
NPI:1356379705
Name:GRIFFIS, JARED TODD (MD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:TODD
Last Name:GRIFFIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 OGLETHORPE AVE
Mailing Address - Street 2:SUITE 600A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2179
Mailing Address - Country:US
Mailing Address - Phone:706-475-4933
Mailing Address - Fax:706-208-8259
Practice Address - Street 1:1199 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2797
Practice Address - Country:US
Practice Address - Phone:706-475-1700
Practice Address - Fax:706-475-1787
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057469207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA035374241DMedicaid
GA035374241IMedicaid
GA035374241JMedicaid
GA00335669OtherRR MEDICARE
GA035374241CMedicaid
GA035374241GMedicaid
GA933586OtherBLUE SHIELD
GA035374241AMedicaid
GA035374241FMedicaid
GA035374241EMedicaid
GA035374241HMedicaid
GAGRP891OtherGA MEDICARE GRP NUMBER
GA933586OtherBLUE SHIELD
GA035374241HMedicaid
GA00335669OtherRR MEDICARE