Provider Demographics
NPI:1114034998
Name:GREENING MEDICAL INC
Entity type:Organization
Organization Name:GREENING MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GREENING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-599-0505
Mailing Address - Street 1:7285 HIGHWAY 16
Mailing Address - Street 2:SUITE C
Mailing Address - City:SENOIA
Mailing Address - State:GA
Mailing Address - Zip Code:30276-3357
Mailing Address - Country:US
Mailing Address - Phone:770-599-0505
Mailing Address - Fax:770-599-3413
Practice Address - Street 1:7285 HIGHWAY 16
Practice Address - Street 2:SUITE C
Practice Address - City:SENOIA
Practice Address - State:GA
Practice Address - Zip Code:30276-3357
Practice Address - Country:US
Practice Address - Phone:770-599-0505
Practice Address - Fax:770-599-3413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55703208VP0000X
GA42585207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000711048QMedicaid
GAGRP7304Medicare PIN
GA000711048QMedicaid