Provider Demographics
NPI:1033102868
Name:GRIFFIN, ALVIN V (MD)
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:V
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1039 E FREEWAY DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5965
Mailing Address - Country:US
Mailing Address - Phone:770-922-0076
Mailing Address - Fax:770-922-0734
Practice Address - Street 1:1039 E FREEWAY DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5965
Practice Address - Country:US
Practice Address - Phone:770-922-0076
Practice Address - Fax:770-922-0734
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2020-05-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA032107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00412849IMedicaid
GA00412849IMedicaid