Healthcare Provider Details

I. General information

NPI: 1487232484
Provider Name (Legal Business Name): SIDNEY ANDREANA GREENE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WOODLAWN DR STE 200
JOHNSON CITY TN
37604-6287
US

IV. Provider business mailing address

107 WOODLAWN DR STE 200
JOHNSON CITY TN
37604-6287
US

V. Phone/Fax

Practice location:
  • Phone: 423-929-7158
  • Fax: 423-928-9625
Mailing address:
  • Phone: 423-929-7158
  • Fax: 423-928-9625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberDO6984
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: