Healthcare Provider Details

I. General information

NPI: 1730384736
Provider Name (Legal Business Name): RICHARD W GREENE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 BUDDY J LN
KNOXVILLE TN
37918-5522
US

IV. Provider business mailing address

7003 BUDDY J LN
KNOXVILLE TN
37918-5522
US

V. Phone/Fax

Practice location:
  • Phone: 865-385-5615
  • Fax:
Mailing address:
  • Phone: 865-385-5615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD12063
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberMD12063
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD12063
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: