Healthcare Provider Details

I. General information

NPI: 1588421507
Provider Name (Legal Business Name): CARRIE GRIFFITH MS, CNS, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30866 WARD RD
SALISBURY MD
21804-2752
US

IV. Provider business mailing address

30866 WARD RD
SALISBURY MD
21804-2752
US

V. Phone/Fax

Practice location:
  • Phone: 443-977-0945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDX6439
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: