Healthcare Provider Details

I. General information

NPI: 1518900034
Provider Name (Legal Business Name): DAVID B GREENFIELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5629 HWY 21 SOUTH
RINCON GA
31326
US

IV. Provider business mailing address

5629 HWY 21 SOUTH
RINCON GA
31326
US

V. Phone/Fax

Practice location:
  • Phone: 912-295-2133
  • Fax: 912-295-5924
Mailing address:
  • Phone: 912-295-2133
  • Fax: 912-295-5924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number26812
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number054567
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: