Healthcare Provider Details

I. General information

NPI: 1386225704
Provider Name (Legal Business Name): ADAM S. GRIFFIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N RANDOLPH ST 2ND FLOOR (PRIVATE OFFICE 246)
CHAMPAIGN IL
61820
US

IV. Provider business mailing address

109 W 27TH ST SUITE 5S
NEW YORK NY
10001-6208
US

V. Phone/Fax

Practice location:
  • Phone: 833-351-8255
  • Fax:
Mailing address:
  • Phone: 833-351-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number342559
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number336.132354
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number76897
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: