Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | MD0000012084 | TN |
NPI | 1922136449 |
---|---|
Provider Name | Winston Henry Griner SR. |
First Address | Nashville, TN 37211-8573 |
Second Address | Nashville, TN 37211-8573 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 02/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BO3378 | (02) | TN |