MEDICARE: HENRY R. GRIFFITH PHD

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	103TC0700X	Clinical Psychologist	1222	AL

General Provider Information

NPI Number	:	1396141222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY R. GRIFFITH PHD

Provider Business Mailing Address
First Line	:	400 VESTAVIA PKWY
Second Line	:	SUITE 130
City	:	VESTAVIA
State	:	AL
Zip	:	35216-3763
Country	:	US
Telephone Number	:	205-823-2373
Fax Number	:	205-823-2378

Provider Business Practice Location Address
First Line	:	400 VESTAVIA PKWY
Second Line	:	SUITE 130
City	:	VESTAVIA
State	:	AL
Zip	:	35216-3763
Country	:	US
Telephone Number	:	205-823-2373
Fax Number	:	205-823-2378

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	DR. HENRY GRIFFITH
Credential	:
Telephone Number	:	205-948-7183

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	11/04/2014

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