Healthcare Provider Details

I. General information

NPI: 1558732438
Provider Name (Legal Business Name): GABRIELLE GRIFFIN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2015
Last Update Date: 02/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

PO BOX 161435
ATLANTA GA
30321-1435
US

V. Phone/Fax

Practice location:
  • Phone: 706-353-1630
  • Fax: 706-543-6825
Mailing address:
  • Phone: 706-369-5440
  • Fax: 706-369-5490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN224132
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN224132
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: