Provider Demographics
NPI:1720274327
Name:GRIFFIN, JAMES WALLACE JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALLACE
Last Name:GRIFFIN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-3700
Mailing Address - Fax:601-450-2493
Practice Address - Street 1:404 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW AUGUSTA
Practice Address - State:MS
Practice Address - Zip Code:39462-0349
Practice Address - Country:US
Practice Address - Phone:601-964-8391
Practice Address - Fax:601-964-8393
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2020-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS19990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS11803908OtherCAQH ID NUMBER
MS9493388P02OtherCIGNA
MS03300361Medicaid
MS9982123OtherAETNA
MSNEW AUGUSTA -1149002OtherWINDSOR HEALTH GROUP
MS302I080218Medicare PIN