Healthcare Provider Details

I. General information

NPI: 1114034998
Provider Name (Legal Business Name): GREENING MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/02/2011
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

7285 HIGHWAY 16 SUITE C
SENOIA GA
30276-3357
US

V. Phone/Fax

Practice location:
  • Phone: 770-599-0505
  • Fax: 770-599-3413
Mailing address:
  • Phone: 770-599-0505
  • Fax: 770-599-3413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number55703
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42585
License Number StateGA

VIII. Authorized Official

Name: DR. BILLY E GREENING
Title or Position: OWNER
Credential: MD
Phone: 770-599-0505