Provider Demographics
NPI:1174998561
Name:GRIGGERS, COURTNEY (BOC PEDORTHIST)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:
Last Name:GRIGGERS
Suffix:
Gender:F
Credentials:BOC PEDORTHIST
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:LOGUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1408
Mailing Address - Country:US
Mailing Address - Phone:478-743-3000
Mailing Address - Fax:478-254-5463
Practice Address - Street 1:1600 FORSYTH ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1408
Practice Address - Country:US
Practice Address - Phone:478-743-3000
Practice Address - Fax:478-254-5463
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAC51359224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist