Healthcare Provider Details

I. General information

NPI: 1467216440
Provider Name (Legal Business Name): MARGARET SPERETHOULA GRIFFIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 VALLEYGATE DR
FAYETTEVILLE NC
28304-3745
US

IV. Provider business mailing address

2936 SKYE DR
FAYETTEVILLE NC
28303-5927
US

V. Phone/Fax

Practice location:
  • Phone: 910-323-5203
  • Fax:
Mailing address:
  • Phone: 910-850-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13985
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: