Provider Demographics
NPI:1053498840
Name:GRIFFIS, GEORGIA (PA)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:GRIFFIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:HOMERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31634-3413
Mailing Address - Country:US
Mailing Address - Phone:912-487-1737
Mailing Address - Fax:912-487-1737
Practice Address - Street 1:30 W FOREST AVE
Practice Address - Street 2:
Practice Address - City:HOMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:31634-3413
Practice Address - Country:US
Practice Address - Phone:912-487-1737
Practice Address - Fax:912-487-1737
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002396AMedicaid
GA002893OtherLICENSE NUMBER
GA1000002396QMedicaid
GAP56496Medicare UPIN