Provider Demographics
NPI:1144997438
Name:GRIFFETH, JACKSON KELLEY (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:KELLEY
Last Name:GRIFFETH
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 JOHNSTON FARM LN
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2646
Mailing Address - Country:US
Mailing Address - Phone:678-617-9725
Mailing Address - Fax:
Practice Address - Street 1:7117 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-2400
Practice Address - Country:US
Practice Address - Phone:770-765-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC124371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics