Healthcare Provider Details

I. General information

NPI: 1093913576
Provider Name (Legal Business Name): MICHAEL GREER MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 05/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 FIDDLERS LN
KINGSTON TN
37763-4020
US

IV. Provider business mailing address

PO BOX 11602
KNOXVILLE TN
37939-1602
US

V. Phone/Fax

Practice location:
  • Phone: 865-776-1023
  • Fax:
Mailing address:
  • Phone: 865-776-1023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberTN019964MD
License Number StateTN

VIII. Authorized Official

Name: DR. DAVID MICHAEL GREER
Title or Position: PRESIDENT
Credential: MD
Phone: 865-776-1023