Provider Demographics
NPI:1104489640
Name:GRIFFIN, PHYONCIA M (CNA)
Entity type:Individual
Prefix:
First Name:PHYONCIA
Middle Name:M
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 SUMMIT PLACE DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5353
Mailing Address - Country:US
Mailing Address - Phone:404-507-4786
Mailing Address - Fax:404-541-3216
Practice Address - Street 1:3190 SUMMIT PLACE DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-5353
Practice Address - Country:US
Practice Address - Phone:404-507-4786
Practice Address - Fax:404-541-3216
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030012917374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty