Basic Information
| Provider Information | |||||||||
| NPI: | 1003070277 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIFFIN-TAYLOR | ||||||||
| FirstName: | BONNYE | ||||||||
| MiddleName: | |||||||||
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| Credential: | CMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 877 JEFFERSON AVE | ||||||||
| Address2: | 5TH FLOOR ADAMS PAVILION | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381032807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015154529 | ||||||||
| FaxNumber: | 9015154599 | ||||||||
| Practice Location | |||||||||
| Address1: | 1064 BREEDLOVE ST | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381072805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9015155400 | ||||||||
| FaxNumber: | 9015261208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2008 | ||||||||
| LastUpdateDate: | 07/16/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 1584 | TN | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.