Basic Information
Provider Information | |||||||||
NPI: | 1861461600 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GRIFFITH | ||||||||
FirstName: | TODD | ||||||||
MiddleName: | ROBERT | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 827 LAMAR ALEXANDER PKWY | ||||||||
Address2: |   | ||||||||
City: | MARYVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 37802 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8659840900 | ||||||||
FaxNumber: | 8659841035 | ||||||||
Practice Location | |||||||||
Address1: | 827 LAMAR ALEXANDER PKWY | ||||||||
Address2: |   | ||||||||
City: | MARYVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 37802 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8659840900 | ||||||||
FaxNumber: | 8659841035 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/15/2006 | ||||||||
LastUpdateDate: | 06/20/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD25523 | TN | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 4461421 | 01 | TN | AETNA | OTHER | 100010120 | 01 | TN | TENNCARE | OTHER | 3084108 | 05 | TN |   | MEDICAID | 1195829 | 01 | TN | UNITED HEALTH CARE | OTHER | 3071395 | 01 | TN | BLUE CROSS BLUE SHIELD | OTHER | TN0137 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | TN0183 | 01 | TN | JOHN DEERE HEALTHCARE | OTHER | 200030072 | 01 | TN | RAILROAD MEDICARE | OTHER |