Healthcare Provider Details

I. General information

NPI: 1568327666
Provider Name (Legal Business Name): JERMOND GRIFFIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 CROSSROADS BLVD STE 25
CARY NC
27518-6892
US

IV. Provider business mailing address

12241 OAKWOOD VIEW DR APT 202
RALEIGH NC
27614-6877
US

V. Phone/Fax

Practice location:
  • Phone: 734-985-8272
  • Fax:
Mailing address:
  • Phone: 734-985-8272
  • Fax: 734-985-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number22249
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: