Provider Demographics
NPI:1366511131
Name:GRIFFIN, LAURIE JANELL (DO)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:JANELL
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:J
Other - Last Name:THIBODEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4123
Mailing Address - Fax:
Practice Address - Street 1:101 E WOOD ST STE 401
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6654
Practice Address - Fax:864-560-7353
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00682412OtherRR MEDICARE
SC008236Medicaid
SC576007863095OtherBCBS OF SC
SCSC45789068Medicare PIN
SCAA08983640Medicare PIN
SC008236Medicaid
SCAA08987951Medicare PIN
SCSC45785019Medicare PIN