Individual
SHANTA L. GRIFFIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
1750 MADISON AVE, SUITE 260, MEMPHIS, TN 38104-6492
(901) 500-5103
(901) 310-9117
Mailing address
PO BOX 21, SOUTHAVEN, MS 38671-0001
(901) 500-5103
(901) 310-9117
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
252
AR
213E00000X
Podiatrist
Primary
711
TN
213ES0103X
Foot & Ankle Surgery Podiatrist
711
TN
213ES0103X
Foot & Ankle Surgery Podiatrist
POD001121
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103I482540
MEDICARE PTAN
TN
05
—
1521566
—
TN
Enumeration date
07/03/2008
Last updated
05/03/2022
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