Provider Demographics
NPI:1447270061
Name:GRIFFITH, JOAN R (MD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:R
Last Name:GRIFFITH
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 1:2457 ROCKMINSTER RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1646
Mailing Address - Country:US
Mailing Address - Phone:858-402-6618
Mailing Address - Fax:
Practice Address - Street 1:2457 ROCKMINSTER RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1646
Practice Address - Country:US
Practice Address - Phone:859-402-6618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37133208000000X, 208D00000X
OH53964208000000X
LAMD.015365208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00337226Medicaid
KY64057169Medicaid
LA2195921Medicaid
LA2195921Medicaid
LA4R0837061Medicare PIN
MS00337226Medicaid