Basic Information
| Provider Information | |||||||||
| NPI: | 1356379705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFIS | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | TODD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 OGLETHORPE AVE | ||||||||
| Address2: | SUITE 600A | ||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064754933 | ||||||||
| FaxNumber: | 7062088259 | ||||||||
| Practice Location | |||||||||
| Address1: | 1199 PRINCE AVE | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062797 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7064751700 | ||||||||
| FaxNumber: | 7064751787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 01/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 057469 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 057469 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 035374241D | 05 | GA | MEDICAID | 035374241I | 05 | GA | MEDICAID | 035374241J | 05 | GA | MEDICAID | 00335669 | 01 | GA | RR MEDICARE | OTHER | 035374241C | 05 | GA | MEDICAID | 035374241G | 05 | GA | MEDICAID | 933586 | 01 | GA | BLUE SHIELD | OTHER | 035374241A | 05 | GA | MEDICAID | 035374241F | 05 | GA | MEDICAID | 035374241E | 05 | GA | MEDICAID | 035374241H | 05 | GA | MEDICAID | GRP891 | 01 | GA | GA MEDICARE GRP NUMBER | OTHER |