Healthcare Provider Details

I. General information

NPI: 1942909478
Provider Name (Legal Business Name): SILAS ALLEN GRIFFIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 INDEPENDENCE
COLUMBUS MS
39710-5300
US

IV. Provider business mailing address

201 INDEPENDENCE
COLUMBUS MS
39710-5300
US

V. Phone/Fax

Practice location:
  • Phone: 662-442-2273
  • Fax: 662-434-7906
Mailing address:
  • Phone: 662-434-2273
  • Fax: 662-434-7906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number84359-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: