Provider Demographics
NPI:1720037708
Name:GRIFFIN, GEORGIA (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 HARRINGTON BLVD.
Mailing Address - Street 2:STE. 206
Mailing Address - City:MT. CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2967
Mailing Address - Country:US
Mailing Address - Phone:586-493-3260
Mailing Address - Fax:586-493-3265
Practice Address - Street 1:1030 HARRINGTON BLVD.
Practice Address - Street 2:STE. 206
Practice Address - City:MT. CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2967
Practice Address - Country:US
Practice Address - Phone:586-493-3260
Practice Address - Fax:586-493-3265
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016677204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4805484Medicaid
MIH75769Medicare UPIN