Healthcare Provider Details

I. General information

NPI: 1801894001
Provider Name (Legal Business Name): JEFFREY D GREENWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 MAYNARDVILLE HWY
MAYNARDVILLE TN
37807-3618
US

IV. Provider business mailing address

1923 SULPHUR SPRINGS RD
MORRISTOWN TN
37813-5654
US

V. Phone/Fax

Practice location:
  • Phone: 865-992-3849
  • Fax: 865-992-5166
Mailing address:
  • Phone: 423-317-9344
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD14635
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: