Healthcare Provider Details

I. General information

NPI: 1245307735
Provider Name (Legal Business Name): GARY S GRIFFIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 CORPORATE SQ
DUBLIN GA
31021-4244
US

IV. Provider business mailing address

4300 N POINT PKWY STE 300
ALPHARETTA GA
30022-4102
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-2599
  • Fax:
Mailing address:
  • Phone: 770-442-1911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number2788561205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number044731
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number044731
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: