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NPI Code Detail

MEDICARE: DR. CHARLES STEWART GREESON MD

MEDICARE: DR. CHARLES STEWART GREESON MD
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
1174400000XSpecialist010621LA
22085R0202XDiagnostic Radiology Physician010621LA

Other Identifiers

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

General Provider Information

NPI Number : 1295788040
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES STEWART GREESON MD
Provider Business Mailing Address
First Line : PO BOX 84110
Second Line :
City : BATON ROUGE
State : LA
Zip : 70884-4110
Country : US
Telephone Number : 225-675-8363
Fax Number : 225-675-8364
Provider Business Practice Location Address
First Line : 6300 MAIN ST
Second Line :
City : ZACHARY
State : LA
Zip : 70791-4037
Country : US
Telephone Number : 225-658-4000
Fax Number : 225-763-9997
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2006
Last Update Date : 05/17/2021

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Directions to “ DR. CHARLES STEWART GREESON MD” Practice Location

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