MEDICARE: DR. THOMAS GRIFFIN III D.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	1223G0001X	General Practice Dentistry	8419	GA

General Provider Information

NPI Number	:	1952312274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS GRIFFIN III D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 670
Second Line	:
City	:	GRAY
State	:	GA
Zip	:	31032-0670
Country	:	US
Telephone Number	:	478-986-6821
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 W CLINTON ST
Second Line	:
City	:	GRAY
State	:	GA
Zip	:	31032-5430
Country	:	US
Telephone Number	:	478-986-6821
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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