Provider Demographics
NPI:1750147955
Name:GRIFFIN, NORRIS JR
Entity type:Individual
Prefix:MR
First Name:NORRIS
Middle Name:
Last Name:GRIFFIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 SE TIFFANY CLUB PL
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7571
Mailing Address - Country:US
Mailing Address - Phone:407-844-1161
Mailing Address - Fax:
Practice Address - Street 1:1611 SE TIFFANY CLUB PL
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7571
Practice Address - Country:US
Practice Address - Phone:407-844-1161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities