Provider Demographics
NPI:1194428854
Name:GRIFFIN, JANICE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 N COCKRELL HILL RD STE 400
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2706
Mailing Address - Country:US
Mailing Address - Phone:469-805-0208
Mailing Address - Fax:
Practice Address - Street 1:1409 N COCKRELL HILL RD STE 400
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2706
Practice Address - Country:US
Practice Address - Phone:469-805-0208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX803242895332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies