Healthcare Provider Details

I. General information

NPI: 1710924998
Provider Name (Legal Business Name): DAUDA A GRIFFIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BECKETT LN SUITE 304
FAYETTEVILLE GA
30214-7155
US

IV. Provider business mailing address

101 BECKETT LN SUITE 304
FAYETTEVILLE GA
30214-7155
US

V. Phone/Fax

Practice location:
  • Phone: 678-519-4142
  • Fax: 678-519-4412
Mailing address:
  • Phone: 678-519-4142
  • Fax: 678-519-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number057468
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number057468
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: