1275872426 NPI number — JOHNNY M. GRIFFIN DDS PC

Table of content: (NPI 1275872426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275872426 NPI number — JOHNNY M. GRIFFIN DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNNY M. GRIFFIN DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275872426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 I85 PKWY STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36106-2833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-274-9861
Provider Business Mailing Address Fax Number:
334-274-9863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 I85 PKWY STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36106-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-274-9861
Provider Business Practice Location Address Fax Number:
334-274-9863
Provider Enumeration Date:
02/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFIN
Authorized Official First Name:
JOHNNY
Authorized Official Middle Name:
MACK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
334-274-9861

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  3420 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009901290 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com