Healthcare Provider Details

I. General information

NPI: 1194153379
Provider Name (Legal Business Name): GREENBRIER CENTER FOR COMPREHENSIVE OTOLARYNGOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 DAWKINS DR
LEWISBURG WV
24901-9674
US

IV. Provider business mailing address

PO BOX 1470
LEWISBURG WV
24901-4470
US

V. Phone/Fax

Practice location:
  • Phone: 304-520-4991
  • Fax: 304-520-4994
Mailing address:
  • Phone: 304-520-4991
  • Fax: 304-520-4994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateWV

VIII. Authorized Official

Name: CHRISTOPHER L WHITE
Title or Position: PHYSICIAN
Credential: DO
Phone: 304-645-0870