Healthcare Provider Details

I. General information

NPI: 1710897913
Provider Name (Legal Business Name): ANISSA GRIFFIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 DELAUNEY AVE STE 101
COLUMBUS GA
31901-3839
US

IV. Provider business mailing address

204 ELMWOOD ST
WARNER ROBINS GA
31093-1806
US

V. Phone/Fax

Practice location:
  • Phone: 706-623-2337
  • Fax:
Mailing address:
  • Phone: 706-623-2337
  • Fax: 706-901-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number124455
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: