Healthcare Provider Details

I. General information

NPI: 1558948752
Provider Name (Legal Business Name): TIMOTHY RALPH GRIFFIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 RUSSELL PKWY STE 700
WARNER ROBINS GA
31088-5765
US

IV. Provider business mailing address

PO BOX 117598
ATLANTA GA
30368-7598
US

V. Phone/Fax

Practice location:
  • Phone: 478-328-7674
  • Fax: 478-328-1393
Mailing address:
  • Phone: 770-442-1911
  • Fax: 770-442-0306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13503
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: