Healthcare Provider Details

I. General information

NPI: 1558168674
Provider Name (Legal Business Name): MOLLY ELIZABETH GREENWAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 WALTON WAY STE 4100
AUGUSTA GA
30901-5107
US

IV. Provider business mailing address

334 RIVER WIND DR
NORTH AUGUSTA SC
29841-6094
US

V. Phone/Fax

Practice location:
  • Phone: 706-722-1381
  • Fax:
Mailing address:
  • Phone: 803-624-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberGAA-NP003180
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: