Healthcare Provider Details

I. General information

NPI: 1326015934
Provider Name (Legal Business Name): DAVID S GREENE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DR. D S GREENE

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 VISION DR
CORNELIA GA
30531-5737
US

IV. Provider business mailing address

120 VISION DR
CORNELIA GA
30531-5737
US

V. Phone/Fax

Practice location:
  • Phone: 706-776-2025
  • Fax: 706-778-4540
Mailing address:
  • Phone: 706-776-2025
  • Fax: 706-778-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number000982
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: