Provider Demographics
NPI:1922364215
Name:GRIFFITH, JESSICA MARIE (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARIE
Other - Last Name:TRACHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 91498
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36691-1498
Mailing Address - Country:US
Mailing Address - Phone:251-460-0326
Mailing Address - Fax:251-460-2846
Practice Address - Street 1:5 MOBILE INFIRMARY CIRCLE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3513
Practice Address - Country:US
Practice Address - Phone:251-460-0326
Practice Address - Fax:251-460-2846
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL33057207ZP0102X, 207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL282871Medicaid