Healthcare Provider Details

I. General information

NPI: 1831052786
Provider Name (Legal Business Name): JAMES TYLER GRIFFIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 DESERT STORM DR
FORT BRAGG NC
28310-9114
US

IV. Provider business mailing address

60 SLATE DR
SPRING LAKE NC
28390-6016
US

V. Phone/Fax

Practice location:
  • Phone: 910-432-7001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberM5083814
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: