Healthcare Provider Details

I. General information

NPI: 1558054262
Provider Name (Legal Business Name): RHEANNAH GRIFFIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5653 FRIST BLVD STE 738
HERMITAGE TN
37076-2066
US

IV. Provider business mailing address

PO BOX 210127
NASHVILLE TN
37221-0127
US

V. Phone/Fax

Practice location:
  • Phone: 615-320-0007
  • Fax: 615-383-6329
Mailing address:
  • Phone: 615-383-2443
  • Fax: 615-383-0853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5541
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number5541
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: