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General NPI Number Information
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NPI Number | 1780613992
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Entity Type | Organization
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Legal Business Name | MICHAEL E. GREENE MD, LLC
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Dates
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Enumeration Date | 07/01/2006
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 682 HEMLOCK ST SUITE 200
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City | MACON
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State | GA
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Zip | 31201-6883
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Country | US
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Telephone | 478-746-3800
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Fax | 478-746-3882
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Provider Business Mailing Address
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Address Line | PO BOX 26940
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City | MACON
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State | GA
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Zip | 31221-6940
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Country | US
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Telephone | 478-746-3800
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Fax | 478-746-3882
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL E GREENE
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Credential | M.D.
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Telephone | 478-746-3800
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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 | 034840
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License Number State | GA
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