MEDICARE: DR. SUSAN MOBLEY GREENE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	074041	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063718187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN MOBLEY GREENE M.D.

Provider Business Mailing Address
First Line	:	101 W MULBERRY BLVD STE 100
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31407-3507
Country	:	US
Telephone Number	:	912-350-5937
Fax Number	:	912-350-3483

Provider Business Practice Location Address
First Line	:	101 W MULBERRY BLVD STE 100
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31407-3507
Country	:	US
Telephone Number	:	912-350-5937
Fax Number	:	912-350-3483

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	12/27/2018

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