Provider Demographics
NPI:1376638502
Name:GRIFFIN, KERRY L (MD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:L
Last Name:GRIFFIN
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 1:1390 CASHIERS WAY
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-6860
Mailing Address - Country:US
Mailing Address - Phone:251-454-0024
Mailing Address - Fax:
Practice Address - Street 1:20 GLENLAKE PARKWAY
Practice Address - Street 2:KAISER PERMANENTE GLENLAKE
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:251-454-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA62042207V00000X
FL99209207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology