Healthcare Provider Details

I. General information

NPI: 1124288790
Provider Name (Legal Business Name): JUDAH NORMAN GREENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 CHARTER BLVD STE 200
MACON GA
31210-4893
US

IV. Provider business mailing address

1180 RESURGENCE DR STE 100
WATKINSVILLE GA
30677-7211
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-5858
  • Fax: 706-543-2050
Mailing address:
  • Phone: 706-543-5858
  • Fax: 706-543-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number66948
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number66948
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: