Healthcare Provider Details

I. General information

NPI: 1053150730
Provider Name (Legal Business Name): ALICIA RENEA GRIFFIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1681 WINCHESTER HWY
FAYETTEVILLE TN
37334-2758
US

IV. Provider business mailing address

1293 WEBB RD
LEWISBURG TN
37091-6851
US

V. Phone/Fax

Practice location:
  • Phone: 931-433-7156
  • Fax:
Mailing address:
  • Phone: 931-993-3373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: