=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194014746
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARLISHA GRIFFITH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2011
-----------------------------------------------------
Last Update Date | 04/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 HOSPITAL DR
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31217-3838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-765-4189
-----------------------------------------------------
Fax | 478-464-5592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 350 HOSPITAL DR
-----------------------------------------------------
City | MACON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31217-3838
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-765-4189
-----------------------------------------------------
Fax | 478-464-5592
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number | L0003226
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------