Provider Demographics
NPI:1538161872
Name:GRIFFIN, GEORGE DJ III (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:DJ
Last Name:GRIFFIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5754 BRIDGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-3100
Mailing Address - Country:US
Mailing Address - Phone:513-481-6100
Mailing Address - Fax:513-481-6954
Practice Address - Street 1:5754 BRIDGETOWN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-3100
Practice Address - Country:US
Practice Address - Phone:513-481-6100
Practice Address - Fax:513-481-6954
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-038479207X00000X
ME013782207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0473018Medicaid
OH0473018Medicaid
OHGR0477751Medicare ID - Type Unspecified