Healthcare Provider Details

I. General information

NPI: 1417795022
Provider Name (Legal Business Name): RACHAELL MARIAH GRIFFIN BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 HIGHWAY 7 S
OXFORD MS
38655-5392
US

IV. Provider business mailing address

152 MS-7
OXFORD MS
38655
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-7521
  • Fax: 662-236-3071
Mailing address:
  • Phone: 662-234-7521
  • Fax: 662-236-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: