Healthcare Provider Details

I. General information

NPI: 1598176380
Provider Name (Legal Business Name): MADISON GRIFFIN LASHLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADISON GUEST GRIFFIN MD

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 09/19/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BAPTIST WAY STE 5C
PENSACOLA FL
32503-2254
US

IV. Provider business mailing address

PO BOX 732892
DALLAS TX
75373-2892
US

V. Phone/Fax

Practice location:
  • Phone: 850-437-8810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME162241
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: