Provider Demographics
NPI:1306894738
Name:GRIFFIN, JOE ASA III (MD)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:ASA
Last Name:GRIFFIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29503-0350
Mailing Address - Country:US
Mailing Address - Phone:843-664-1122
Mailing Address - Fax:843-664-1805
Practice Address - Street 1:513 S DARGAN STREET
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2549
Practice Address - Country:US
Practice Address - Phone:843-664-1122
Practice Address - Fax:843-664-1805
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC146782086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3789OtherMEDICAID GROUP
SC7731Medicare PIN
SCE15034Medicare UPIN