Basic Information
| Provider Information | |||||||||
| NPI: | 1588820278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRIFFITH | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | BRYAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 PEACHTREE RD NE | ||||||||
| Address2: | SUITE 705 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091476 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043550743 | ||||||||
| FaxNumber: | 4043552136 | ||||||||
| Practice Location | |||||||||
| Address1: | 1505 NORTHSIDE BLVD | ||||||||
| Address2: | SUITE 3100 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300417623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709777777 | ||||||||
| FaxNumber: | 8552838851 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2008 | ||||||||
| LastUpdateDate: | 10/12/2015 | ||||||||
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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 | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207X00000X | 51924 | MN | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 072612 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | ENROLLED | 05 | IA | MEDICAID | ENROLLED | 05 | MN | MEDICAID |