Healthcare Provider Details

I. General information

NPI: 1336613108
Provider Name (Legal Business Name): GREG ANTHONY MORENTIN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 US HIGHWAY 17
RICHMOND HILL GA
31324-3398
US

IV. Provider business mailing address

2324 US HIGHWAY 17
RICHMOND HILL GA
31324-3398
US

V. Phone/Fax

Practice location:
  • Phone: 912-756-2531
  • Fax:
Mailing address:
  • Phone: 912-756-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN237806
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: