MEDICARE: MRS. DAWN S. GRISWOLD CRC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744R1102X	Research Study Specialist

General Provider Information

NPI Number	:	1134380785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN S. GRISWOLD CRC

Provider Business Mailing Address
First Line	:	4243 SUNBEAM RD STE 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8975
Country	:	US
Telephone Number	:	904-448-0233
Fax Number	:	904-448-0238

Provider Business Practice Location Address
First Line	:	4243 SUNBEAM RD STE 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8975
Country	:	US
Telephone Number	:	904-448-0233
Fax Number	:	904-448-0238

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/17/2008

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