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General NPI Number Information
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NPI Number | 1588827109
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Entity Type | Individual
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Provider Name | SHANTA L. GRIFFIN DPM
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Gender | Female
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 05/03/2022
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Provider Practice Location Address
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Address Line | 1750 MADISON AVE SUITE 260
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City | MEMPHIS
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State | TN
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Zip | 38104-6492
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Country | US
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Telephone | 901-500-5103
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Fax | 901-310-9117
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Provider Business Mailing Address
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Address Line | PO BOX 21
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City | SOUTHAVEN
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State | MS
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Zip | 38671-0001
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Country | US
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Telephone | 901-500-5103
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Fax | 901-310-9117
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 252
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD001121
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 711
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 711
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License Number State | TN
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