Provider Demographics
NPI:1144823725
Name:GRIFFETH, PATRICIA LACEY
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LACEY
Last Name:GRIFFETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5848 HIGHWAY 124 W
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-5900
Mailing Address - Country:US
Mailing Address - Phone:706-654-1439
Mailing Address - Fax:706-654-2946
Practice Address - Street 1:5848 HIGHWAY 124 W
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-5900
Practice Address - Country:US
Practice Address - Phone:706-654-1439
Practice Address - Fax:706-654-2946
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013331183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist