MEDICARE: WAKITHA A. GRIFFIN M.D.

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	174400000X	Specialist	051138	GA

General Provider Information

NPI Number	:	1437141728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAKITHA A. GRIFFIN M.D.

Provider Business Mailing Address
First Line	:	550 PEACHTREE ST NE
Second Line	:	SUITE 1490
City	:	ATLANTA
State	:	GA
Zip	:	30308-2208
Country	:	US
Telephone Number	:	404-523-4223
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE
Second Line	:	SUITE 1490
City	:	ATLANTA
State	:	GA
Zip	:	30308-2208
Country	:	US
Telephone Number	:	404-523-4223
Fax Number	:

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	11/08/2022

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