Healthcare Provider Details

I. General information

NPI: 1609941665
Provider Name (Legal Business Name): GEORGE W GRIFFITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GEORGE W GRIFFITH MD

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NEWCOMB AVE
MOUNT VERNON KY
40456-2725
US

IV. Provider business mailing address

PO BOX 1405
MOUNT VERNON KY
40456-1405
US

V. Phone/Fax

Practice location:
  • Phone: 606-256-2961
  • Fax: 606-256-3562
Mailing address:
  • Phone: 606-256-2961
  • Fax: 606-256-3562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17377
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: