Healthcare Provider Details

I. General information

NPI: 1659321099
Provider Name (Legal Business Name): BILLY EUGENE GREENING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7285 HIGHWAY 16 SUITE C
SENOIA GA
30276-3357
US

IV. Provider business mailing address

PO BOX 102321
ATLANTA GA
30368-2321
US

V. Phone/Fax

Practice location:
  • Phone: 770-599-0505
  • Fax:
Mailing address:
  • Phone: 770-599-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42585
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: