Healthcare Provider Details

I. General information

NPI: 1689773681
Provider Name (Legal Business Name): GREENWOOD PEDIATRICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 E COUNTY LINE RD SUITE B2
INDIANAPOLIS IN
46227-2932
US

IV. Provider business mailing address

1030 E COUNTY LINE RD SUITE B2
INDIANAPOLIS IN
46227-2932
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-6060
  • Fax: 317-859-5946
Mailing address:
  • Phone: 317-887-6060
  • Fax: 317-859-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: DR. CAROL G JOHNSON
Title or Position: VP
Credential: MD
Phone: 317-887-6060