Provider Demographics
NPI:1427281294
Name:GRIGGS FAMILY PRACTICE, LLC
Entity type:Organization
Organization Name:GRIGGS FAMILY PRACTICE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:GRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-529-4266
Mailing Address - Street 1:1020 CHATTANOOGA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8880
Mailing Address - Country:US
Mailing Address - Phone:706-529-4266
Mailing Address - Fax:706-529-4269
Practice Address - Street 1:1020 CHATTANOOGA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8880
Practice Address - Country:US
Practice Address - Phone:706-529-4266
Practice Address - Fax:706-529-4269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7704Medicare PIN
GAI17624Medicare UPIN