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General NPI Number Information
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NPI Number | 1215374426
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Entity Type | Individual
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Provider Name | JUSTIN MATTHEW GREENFIELD
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Gender | Male
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 2095 HENRY TECKLENBURG DR
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City | CHARLESTON
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State | SC
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Zip | 29414-5733
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Country | US
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Telephone | 843-402-1436
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Fax | 843-402-1833
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Provider Business Mailing Address
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Address Line | PO BOX 603484
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City | CHARLOTTE
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State | NC
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Zip | 28260-3484
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Country | US
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Telephone | 803-765-1838
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Fax | 803-765-1732
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN195971
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN195971
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License Number State | GA
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