Provider Demographics
NPI:1114487105
Name:GRIFFIN, RUTH ALLISON (CRNP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ALLISON
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:ALLISON
Other - Last Name:MCMILLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:225 MAPLE VIEW DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-8471
Mailing Address - Country:US
Mailing Address - Phone:770-812-5678
Mailing Address - Fax:770-812-5767
Practice Address - Street 1:225 MAPLE VIEW DR STE 102
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-8471
Practice Address - Country:US
Practice Address - Phone:770-812-5678
Practice Address - Fax:770-812-5767
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN316673363LF0000X
AL1-166658363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily