Provider Demographics
NPI:1740627751
Name:GRIFFITH, WILMA L (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:L
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21953 COUNTY ROAD 124
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:OH
Mailing Address - Zip Code:43845-9653
Mailing Address - Country:US
Mailing Address - Phone:740-502-9617
Mailing Address - Fax:
Practice Address - Street 1:1410 WALNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2239
Practice Address - Country:US
Practice Address - Phone:740-295-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric