Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 14678 | SC |
NPI | 1306894738 |
---|---|
Provider Name | Mr. Joe Asa Griffin III |
First Address | Florence, SC 29503-0350 |
Second Address | Florence, SC 29506-2549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 04/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E15034 | (02) | SC |
GP3789 | MEDICAID GROUP (01) | SC |