1376753871 NPI number — DR. HEATHER LOVETT GRIFFIN HEATHER GRIFFIN

Table of content: DR. HEATHER LOVETT GRIFFIN HEATHER GRIFFIN (NPI 1376753871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376753871 NPI number — DR. HEATHER LOVETT GRIFFIN HEATHER GRIFFIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFIN
Provider First Name:
HEATHER
Provider Middle Name:
LOVETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
HEATHER GRIFFIN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRIFFIN
Provider Other First Name:
HEATHER
Provider Other Middle Name:
LOVETT
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
HEATHER GRIFFIN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1376753871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8278 THORNE DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARTLETT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-752-3949
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 HORIZON LAKE DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38133-8119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-882-7820
Provider Business Practice Location Address Fax Number:
901-384-8002
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  13053 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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