Provider Demographics
NPI:1720145352
Name:GRIFFIN, CLIFFORD STANLEY SR (DC)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:STANLEY
Last Name:GRIFFIN
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S ENOTA DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-532-4084
Mailing Address - Fax:770-532-9857
Practice Address - Street 1:700 S ENOTA DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-532-4084
Practice Address - Fax:770-532-9857
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2451111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
352CB2LMedicare ID - Type Unspecified
T33423Medicare UPIN