MEDICARE: MARQUIS GRIFFIN

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RC0000X	Cardiovascular Disease Physician	104253	GA

General Provider Information

NPI Number	:	1275094559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUIS GRIFFIN

Provider Business Mailing Address
First Line	:	9212 SAINT CLAIR DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-2698
Country	:	US
Telephone Number	:	706-564-6665
Fax Number	:

Provider Business Practice Location Address
First Line	:	1364 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1900
Country	:	US
Telephone Number	:	404-712-2000
Fax Number	:

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

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	06/10/2025

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Directions to “ MARQUIS GRIFFIN ” Practice Location

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