Healthcare Provider Details

I. General information

NPI: 1134651128
Provider Name (Legal Business Name): AUSTIN TAYLOR GREENWOOD FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 PHILIPS FARM RD
COLUMBIA MO
65201-0067
US

IV. Provider business mailing address

2358 LIFESTYLE WAY SUITE 212
CHATTANOOGA TN
37421-2291
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4800
  • Fax: 573-884-0723
Mailing address:
  • Phone: 423-521-1100
  • Fax: 423-521-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number22474
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number22474
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22474
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023032737
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: