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General NPI Number Information
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NPI Number | 1679432165
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Entity Type | Individual
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Provider Name | MRS. LISA GRIFFIN-MOH
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Gender | Female
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Dates
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Enumeration Date | 01/20/2026
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 9442 S MAIN ST STE 118
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City | JONESBORO
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State | GA
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Zip | 30236-6073
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Country | US
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Telephone | 678-360-6003
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2327
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City | JONESBORO
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State | GA
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Zip | 30237-2327
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Country | US
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Telephone | 678-360-6003
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN112512
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License Number State | GA
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