Provider Demographics
NPI:1972594919
Name:GRIFFIN, AMY BARILLEAUX (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BARILLEAUX
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 BUSH AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-5317
Mailing Address - Country:US
Mailing Address - Phone:318-473-2324
Mailing Address - Fax:
Practice Address - Street 1:5408 PROVINE PL
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3772
Practice Address - Country:US
Practice Address - Phone:318-445-0075
Practice Address - Fax:318-445-4142
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1048470Medicaid
LAI19969Medicare UPIN