=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114034998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREENING MEDICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 11/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7285 HIGHWAY 16 SUITE C
-----------------------------------------------------
City | SENOIA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30276-3357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-599-0505
-----------------------------------------------------
Fax | 770-599-3413
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7285 HIGHWAY 16 SUITE C
-----------------------------------------------------
City | SENOIA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30276-3357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-599-0505
-----------------------------------------------------
Fax | 770-599-3413
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BILLY E GREENING
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 770-599-0505
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0000X
-----------------------------------------------------
Taxonomy Name | Pain Medicine Physician
-----------------------------------------------------
License Number | 55703
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 42585
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------