Provider Demographics
NPI:1932255080
Name:GRIGGS, GERALD A (DMD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:A
Last Name:GRIGGS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:201 PAT A HARALSON DRIVE
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514-0760
Mailing Address - Country:US
Mailing Address - Phone:706-745-9999
Mailing Address - Fax:706-745-9997
Practice Address - Street 1:201 PAT A HARALSON DRIVE
Practice Address - Street 2:201 PAT A HARALSON DRIVE
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30514-0760
Practice Address - Country:US
Practice Address - Phone:706-745-9999
Practice Address - Fax:706-745-9997
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0128441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA712404964AMedicaid
GA9182381OtherDORAL