Healthcare Provider Details

I. General information

NPI: 1619679503
Provider Name (Legal Business Name): MORGAN GILMER GREENE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 STEELES RD STE 2
BRISTOL TN
37620-9532
US

IV. Provider business mailing address

350 STEELES RD STE 2
BRISTOL TN
37620-9532
US

V. Phone/Fax

Practice location:
  • Phone: 423-844-6700
  • Fax:
Mailing address:
  • Phone: 423-844-6700
  • Fax: 866-334-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6817
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: