Provider Demographics
NPI:1063718187
Name:GREENE, SUSAN MOBLEY (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MOBLEY
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W MULBERRY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-3507
Mailing Address - Country:US
Mailing Address - Phone:912-350-5937
Mailing Address - Fax:912-350-3483
Practice Address - Street 1:101 W MULBERRY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31407-3507
Practice Address - Country:US
Practice Address - Phone:912-350-5937
Practice Address - Fax:912-350-3483
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA074041207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003162507AMedicaid
GAPENDINGMedicare PIN