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General NPI Number Information
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NPI Number | 1396165577
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Entity Type | Organization
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Legal Business Name | JAMES W GREENE MD LLC
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 3215 SHRINE RD STE 3
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City | BRUNSWICK
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State | GA
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Zip | 31520-4300
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Country | US
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Telephone | 912-434-9164
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Fax | 912-434-9386
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Provider Business Mailing Address
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Address Line | 1015 ARTHUR J MOORE DR # 2
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City | SAINT SIMONS IS
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State | GA
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Zip | 31522-2206
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Country | US
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Telephone | 912-434-9164
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES WALTER GREENE
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Credential | MD
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Telephone | 912-434-9164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 029657
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License Number State | GA
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