MEDICARE: GREENBRIER FAMILY PRACTICE, P.C.

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	207Q00000X	Family Medicine Physician	0101039112	VA

General Provider Information

NPI Number	:	1174793400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENBRIER FAMILY PRACTICE, P.C.

Provider Business Mailing Address
First Line	:	1021 EDEN WAY N STE 109
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-2776
Country	:	US
Telephone Number	:	757-547-0999
Fax Number	:	757-547-0770

Provider Business Practice Location Address
First Line	:	1021 EDEN WAY N STE 109
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-2776
Country	:	US
Telephone Number	:	757-547-0999
Fax Number	:	757-547-0770

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LISA SHEA KENNEDY
Credential	:	M.D.
Telephone Number	:	757-547-0999

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	03/10/2008

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