Healthcare Provider Details

I. General information

NPI: 1629050059
Provider Name (Legal Business Name): BRIAN D GREENE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 TOWN CENTER DR
ANNISTON AL
36205-4101
US

IV. Provider business mailing address

PO BOX 5430
ANNISTON AL
36205-0430
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-1624
  • Fax: 256-241-2277
Mailing address:
  • Phone: 256-237-1624
  • Fax: 256-241-2277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberBG086607
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number30509
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: