MEDICARE: JAMES ROBERT GRIFFITH PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1423	WI
2	363AM0700X	Medical Physician Assistant	2014011852	MO
3	363A00000X	Physician Assistant	0010-13738	NC

General Provider Information

NPI Number	:	1376652412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES ROBERT GRIFFITH PAC

Provider Business Mailing Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-6674
Fax Number	:	336-716-9188

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-2232
Country	:	US
Telephone Number	:	336-716-6674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/18/2024

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