Provider Demographics
NPI:1528176310
Name:GRIFFIETH, GARY G (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:G
Last Name:GRIFFIETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 KILRUSH DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-4198
Mailing Address - Country:US
Mailing Address - Phone:615-339-8110
Mailing Address - Fax:877-305-3637
Practice Address - Street 1:310 25TH AVE N
Practice Address - Street 2:STE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1515
Practice Address - Country:US
Practice Address - Phone:615-329-0195
Practice Address - Fax:615-329-0211
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197191208000000X, 2080P0006X
TN48969208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070803000061OtherFIDELIS/DEVELOPMENTAL PED
NY060915000050OtherFIDELIS
NY10000811OtherCDPHP
NY200052OtherSENIOR WHOLE HEALTH
NY47337OtherGHI/HMO
NY000401693002OtherBSNENY
NY5848474OtherAETNA
NY26219OtherMVP
NY01698842Medicaid
NY550731OtherEMPIRE BC
NY6007013OtherMVP/DEVELOP BEHAV PEDS