Healthcare Provider Details

I. General information

NPI: 1194834218
Provider Name (Legal Business Name): DORIS M GREENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 PAULSEN STREET
SAVANNAH GA
31405
US

IV. Provider business mailing address

5120 PAULSEN STREET
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-4953
  • Fax: 912-352-1056
Mailing address:
  • Phone: 912-354-4953
  • Fax: 912-352-1056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number18658
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: