Healthcare Provider Details

I. General information

NPI: 1205919594
Provider Name (Legal Business Name): GEORGE W GRIFFITH MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E, MAIN ST
MT VERNON KY
40456-0609
US

IV. Provider business mailing address

PO BOX 609
MT VERNON KY
40456
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: MR. GEORGE W GRIFFITH
Title or Position: PRESIDENT
Credential: MD
Phone: 606-256-2961