Healthcare Provider Details

I. General information

NPI: 1891703054
Provider Name (Legal Business Name): HENRY RANDALL GRIFFITH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VESTAVIA PKWY STE 130
VESTAVIA AL
35216-3750
US

IV. Provider business mailing address

3438 CHAPEL HILLS PKWY
FULTONDALE AL
35068-6081
US

V. Phone/Fax

Practice location:
  • Phone: 205-823-2373
  • Fax: 205-823-2378
Mailing address:
  • Phone: 205-948-7183
  • Fax: 205-719-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: