Provider Demographics
NPI:1982908422
Name:GRIFFIN, ROGER E (RN-BC)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:E
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 PARTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4160
Mailing Address - Country:US
Mailing Address - Phone:229-227-6382
Mailing Address - Fax:
Practice Address - Street 1:531 PARTRIDGE DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4160
Practice Address - Country:US
Practice Address - Phone:229-227-6382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-25
Last Update Date:2010-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN180803163WP0808X
FLRN9268271163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health