Basic Information
| Provider Information | |||||||||
| NPI: | 1740803774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFIN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | PETER | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, RN, CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3540 STONEY BROOK DR APT 207 | ||||||||
| Address2: | |||||||||
| City: | FULTONDALE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 350682263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2566825499 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1813 6TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2020 | ||||||||
| LastUpdateDate: | 05/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1-136755 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.