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General NPI Number Information
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NPI Number | 1730776535
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Entity Type | Individual
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Provider Name | ALEXANDER EVAN GREESON PTA
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Gender | Male
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 1611 LAWRENCEVILLE SUWANEE RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-3593
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Country | US
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Telephone | 470-329-0733
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Fax |
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Provider Business Mailing Address
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Address Line | 176 SOUTHAMPTON CIR
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City | HOSCHTON
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State | GA
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Zip | 30548-6800
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Country | US
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Telephone | 770-374-9088
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA001953
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License Number State | GA
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