MEDICARE: STACEY ELIZABETH GRIFFIN CSFA

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	246ZC0007X	Surgical Assistant	154439	TN

General Provider Information

NPI Number	:	1952262040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY ELIZABETH GRIFFIN CSFA

Provider Business Mailing Address
First Line	:	1133 MONROE CIR
Second Line	:
City	:	MADISONVILLE
State	:	TN
Zip	:	37354-5903
Country	:	US
Telephone Number	:	865-403-2022
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 CHURCH ST
Second Line	:
City	:	SWEETWATER
State	:	TN
Zip	:	37874-2897
Country	:	US
Telephone Number	:	865-213-8200
Fax Number	:

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

Provider Enumeration Date	:	11/19/2025
Last Update Date	:	11/19/2025

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