Healthcare Provider Details

I. General information

NPI: 1437587813
Provider Name (Legal Business Name): MEGAN GRIFFIN MS RD LD CHES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 ASHLEY AVE EH 110B, MSC 905
CHARLESTON SC
29425-8905
US

IV. Provider business mailing address

165 ASHLEY AVE EH 110B, MSC 905
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-9774
  • Fax:
Mailing address:
  • Phone: 843-792-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number1148
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: