Healthcare Provider Details

I. General information

NPI: 1548493000
Provider Name (Legal Business Name): HENRY R. GRIFFITH, PH.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 23RD ST S SUITE 100, MAGNOLIA FINANCIAL BUILDING
BIRMINGHAM AL
35205-2499
US

IV. Provider business mailing address

1025 23RD ST S SUITE 100, MAGNOLIA FINANCIAL BUILDING
BIRMINGHAM AL
35205-2499
US

V. Phone/Fax

Practice location:
  • Phone: 205-324-8499
  • Fax:
Mailing address:
  • Phone: 205-324-8499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1222
License Number StateAL

VIII. Authorized Official

Name: HENRY R. GRIFFITH
Title or Position: PSYCHOLOGIST / OWNER
Credential: PH.D.
Phone: 205-324-8499