MEDICARE: DR. MACK W GRIFFITH MD

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	31509	TN
2	207L00000X	Anesthesiology Physician	31509	TN

General Provider Information

NPI Number	:	1487658951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MACK W GRIFFITH MD

Provider Business Mailing Address
First Line	:	111 HIGHWAY 70 E
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2080
Country	:	US
Telephone Number	:	615-326-2870
Fax Number	:	615-326-2841

Provider Business Practice Location Address
First Line	:	111 HIGHWAY 70 E
Second Line	:
City	:	DICKSON
State	:	TN
Zip	:	37055-2080
Country	:	US
Telephone Number	:	615-326-2870
Fax Number	:	615-326-2841

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

Provider Enumeration Date	:	06/11/2005
Last Update Date	:	12/31/2012

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