Healthcare Provider Details

I. General information

NPI: 1447165220
Provider Name (Legal Business Name): NICHOLAS GREINER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 EMERALD PL STE 201
GREENVILLE NC
27834-5743
US

IV. Provider business mailing address

4009 LACROUX CT
OCEAN SPRINGS MS
39564-1418
US

V. Phone/Fax

Practice location:
  • Phone: 845-545-0923
  • Fax:
Mailing address:
  • Phone: 228-806-9030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: