Healthcare Provider Details

I. General information

NPI: 1891414066
Provider Name (Legal Business Name): GEORGIA GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5949 HARBOUR PARK DR
MIDLOTHIAN VA
23112-2163
US

IV. Provider business mailing address

1500 S DOUGLAS RD STE 230
CORAL GABLES FL
33134-4108
US

V. Phone/Fax

Practice location:
  • Phone: 804-352-6456
  • Fax:
Mailing address:
  • Phone: 844-854-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB806866
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: