Healthcare Provider Details

I. General information

NPI: 1922923796
Provider Name (Legal Business Name): BENJAMIN THOMAS GRISWOLD LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 JACKSON MILL RD
DEMOREST GA
30535-2102
US

IV. Provider business mailing address

280 JACKSON MILL RD
DEMOREST GA
30535-2102
US

V. Phone/Fax

Practice location:
  • Phone: 706-200-8864
  • Fax:
Mailing address:
  • Phone: 706-200-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW013336
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: