Healthcare Provider Details

I. General information

NPI: 1194014746
Provider Name (Legal Business Name): ARLISHA GRIFFITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 HOSPITAL DR
MACON GA
31217-3838
US

IV. Provider business mailing address

350 HOSPITAL DR
MACON GA
31217-3838
US

V. Phone/Fax

Practice location:
  • Phone: 478-765-4189
  • Fax: 478-464-5592
Mailing address:
  • Phone: 478-765-4189
  • Fax: 478-464-5592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL0003226
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: