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General NPI Number Information
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NPI Number | 1760913453
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Entity Type | Individual
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Provider Name | AUSTIN GREENHAW M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2017
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 801 7TH AVE
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City | FORT WORTH
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State | TX
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Zip | 76104-2733
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Country | US
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Telephone | 682-885-1055
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Fax | 682-885-1062
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Provider Business Mailing Address
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Address Line | PO BOX 733784
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City | DALLAS
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State | TX
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Zip | 75373-3784
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Country | US
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Telephone | 682-885-6483
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Fax | 682-885-3113
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 287760
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | U3858
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License Number State | TX
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