1497052591 NPI number — MICHAEL GRIFFIN PC

Table of content: (NPI 1497052591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497052591 NPI number — MICHAEL GRIFFIN PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL GRIFFIN 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:
6
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:
1497052591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
206 MEDICAL CARE WAY
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
DOTHAN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36303-4765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-794-8797
Provider Business Mailing Address Fax Number:
334-479-0658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 ROSS CLARK CIR
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36301-4765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-479-0043
Provider Business Practice Location Address Fax Number:
334-792-8630
Provider Enumeration Date:
02/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GRIFFIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ALVIN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
334-479-0043

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  S774-TA-431 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 156FX1800X , with the licence number: S774-TA-431 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 127693 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com