MEDICARE: GEORGE 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	207Q00000X	Family Medicine Physician	17377	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1342894	OTHER	KY	COVENTRY CARES
2	10006897	OTHER	KY	KY COOPERATIVE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	596965	OTHER	KY	WELLCARE
5	000000790871	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1609941665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE W GRIFFITH MD

Provider Business Mailing Address
First Line	:	PO BOX 1405
Second Line	:
City	:	MOUNT VERNON
State	:	KY
Zip	:	40456-1405
Country	:	US
Telephone Number	:	606-256-2961
Fax Number	:	606-256-3562

Provider Business Practice Location Address
First Line	:	140 NEWCOMB AVE
Second Line	:
City	:	MOUNT VERNON
State	:	KY
Zip	:	40456-2725
Country	:	US
Telephone Number	:	606-256-2961
Fax Number	:	606-256-3562

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	03/29/2018

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