Basic Information
| Provider Information | |||||||||
| NPI: | 1477636629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIFFIN | ||||||||
| FirstName: | DAVIDA | ||||||||
| MiddleName: | J | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 RIDGE VIEW DR | ||||||||
| Address2: | STE 105 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275115589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198597044 | ||||||||
| FaxNumber: | 9198597052 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 RIDGE VIEW DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275115589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198597044 | ||||||||
| FaxNumber: | 9198597052 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 11/16/2017 | ||||||||
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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 | 363AM0700X | 103439 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.