Individual
DR. JAMES WALLACE GRIFFIN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
404 MAIN STREET, NEW AUGUSTA, MS 39462-0349
(601) 964-8391
(601) 964-8393
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-3700
(601) 450-2493
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
19990
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03300361
—
MS
01
—
11803908
CAQH ID NUMBER
MS
01
—
9493388P02
CIGNA
MS
01
—
9982123
AETNA
MS
01
—
NEW AUGUSTA -1149002
WINDSOR HEALTH GROUP
MS
Enumeration date
09/18/2007
Last updated
01/17/2020
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