MEDICARE: MRS. ANN LACOUTURE GRIFFIN PA-C

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	363AM0700X	Medical Physician Assistant	1201	SC

General Provider Information

NPI Number	:	1710159033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANN LACOUTURE GRIFFIN PA-C

Provider Business Mailing Address
First Line	:	852 LOWCOUNTRY BLVD STE 102
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3067
Country	:	US
Telephone Number	:	843-216-3530
Fax Number	:	843-654-9122

Provider Business Practice Location Address
First Line	:	852 LOWCOUNTRY BLVD STE 102
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3067
Country	:	US
Telephone Number	:	843-216-3530
Fax Number	:	843-654-9122

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

Provider Enumeration Date	:	03/26/2008
Last Update Date	:	04/25/2013

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