Healthcare Provider Details

I. General information

NPI: 1396738878
Provider Name (Legal Business Name): DONALD LEE GRIFFIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date: 03/25/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

14410 ROUTE 37
JOHNSTON CITY IL
62951-3166
US

IV. Provider business mailing address

PO BOX 155 CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORP.
CHRISTOPHER IL
62822
US

V. Phone/Fax

Practice location:
  • Phone: 618-937-6409
  • Fax: 618-937-1619
Mailing address:
  • Phone: 618-724-2401
  • Fax: 618-724-2571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036039250
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: