MEDICARE: JOHNEL GRIGGS

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1508222076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNEL GRIGGS

Provider Business Mailing Address
First Line	:	14026 CRESTWICK DR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-8432
Country	:	US
Telephone Number	:	904-535-2057
Fax Number	:	904-570-9174

Provider Business Practice Location Address
First Line	:	14026 CRESTWICK DR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-8432
Country	:	US
Telephone Number	:	904-535-2057
Fax Number	:	904-570-9174

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

Provider Enumeration Date	:	01/13/2016
Last Update Date	:	01/13/2016

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Directions to “ JOHNEL GRIGGS ” Practice Location

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