Provider Demographics
NPI:1043263528
Name:GREENVILLE PSYCHIATRIC ASSOCIATES, PA
Entity Type:Organization
Organization Name:GREENVILLE PSYCHIATRIC ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-758-4810
Mailing Address - Street 1:PO BOX 20128
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-0128
Mailing Address - Country:US
Mailing Address - Phone:252-758-4810
Mailing Address - Fax:252-758-3790
Practice Address - Street 1:502 RED BANKS RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5751
Practice Address - Country:US
Practice Address - Phone:252-758-4810
Practice Address - Fax:252-758-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC230438Medicare ID - Type UnspecifiedMEDICARE