Healthcare Provider Details

I. General information

NPI: 1114931144
Provider Name (Legal Business Name): SANDY LAFAYE GRIFFIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N EDWARDS ST
ENTERPRISE AL
36330-2510
US

IV. Provider business mailing address

400 N EDWARDS ST
ENTERPRISE AL
36330-2510
US

V. Phone/Fax

Practice location:
  • Phone: 334-347-0584
  • Fax: 334-347-2080
Mailing address:
  • Phone: 334-347-0584
  • Fax: 334-347-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-042973
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN-CRNA235330
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: