Provider Demographics
NPI:1508222076
Name:GRIGGS, JOHNEL
Entity Type:Individual
Prefix:
First Name:JOHNEL
Middle Name:
Last Name:GRIGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14026 CRESTWICK DR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8432
Mailing Address - Country:US
Mailing Address - Phone:904-535-2057
Mailing Address - Fax:904-570-9174
Practice Address - Street 1:14026 CRESTWICK DR E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8432
Practice Address - Country:US
Practice Address - Phone:904-535-2057
Practice Address - Fax:904-570-9174
Is Sole Proprietor?:No
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker