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General NPI Number Information
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NPI Number | 1790740132
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Entity Type | Individual
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Provider Name | JOHN MICHAEL GRIFFIN PHD
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Gender | Male
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 307 B DOGWOOD LANE
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City | EMPORIA
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State | VA
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Zip | 23847
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Country | US
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Telephone | 434-634-7676
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Fax | 434-634-7676
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Provider Business Mailing Address
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Address Line | PO BOX 2161
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City | ROANOKE RAPIDS
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State | NC
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Zip | 27870-7161
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Country | US
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Telephone | 252-537-6164
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Fax | 252-537-9199
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1541
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License Number State | NC
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