Provider Demographics
NPI:1043419229
Name:GREENVILLE, BILLY J (HIS)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:J
Last Name:GREENVILLE
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75654-3946
Mailing Address - Country:US
Mailing Address - Phone:903-657-1702
Mailing Address - Fax:903-657-4560
Practice Address - Street 1:709 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-3946
Practice Address - Country:US
Practice Address - Phone:903-657-1702
Practice Address - Fax:903-657-4560
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50486174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist