Provider Demographics
NPI:1518097815
Name:GRIFFITH, CAMERON S (MD, MS)
Entity type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:S
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:112 WATERFORD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2931
Mailing Address - Country:US
Mailing Address - Phone:318-464-0306
Mailing Address - Fax:
Practice Address - Street 1:1420 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3107
Practice Address - Country:US
Practice Address - Phone:601-264-3937
Practice Address - Fax:601-264-5930
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59069207W00000X
MS20249207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS20249OtherMISSISSIPPI MEDICAL LICENSE
GA59069OtherMEDICAL LICENSE
MS04175796Medicaid
MS512G490003OtherGROUP MEDICARE PTAN FOR SOUTHERN EYE SURGERY CENTER LLC
MS04175796Medicaid
GA59069OtherMEDICAL LICENSE