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General NPI Number Information
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NPI Number | 1093864662
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Entity Type | Organization
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Legal Business Name | GREENVILLE INTERNAL MEDICINE
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 2210 HEMBY LN SUITE 101
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City | GREENVILLE
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State | NC
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Zip | 27834-3773
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Country | US
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Telephone | 252-830-1680
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Fax | 252-830-0926
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Provider Business Mailing Address
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Address Line | 800 MOYE BLVD
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City | GREENVILLE
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State | NC
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Zip | 27834-3777
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Country | US
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Telephone | 252-830-1680
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Fax | 252-830-0926
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEO E. WAIVERS
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Credential | MD
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Telephone | 252-830-1680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 56908
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License Number State | NC
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