Basic Information
| Provider Information | |||||||||
| NPI: | 1093856601 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFIN | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | TALMADGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701184828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048641343 | ||||||||
| FaxNumber: | 5048947290 | ||||||||
| Practice Location | |||||||||
| Address1: | 3450 CHESTNUT ST | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701152443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5044121580 | ||||||||
| FaxNumber: | 5044121530 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 11/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 292 | LA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1963933 | 05 | LA | MEDICAID |