Provider Demographics
NPI:1073834792
Name:GREVENITIS, PANAYIOTIS P (MD)
Entity Type:Individual
Prefix:MR
First Name:PANAYIOTIS
Middle Name:P
Last Name:GREVENITIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 HONEYSUCKLE RD
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36305-1156
Mailing Address - Country:US
Mailing Address - Phone:334-836-1212
Mailing Address - Fax:
Practice Address - Street 1:3601 SPRINGHILL BUSINESS PARK STE 201
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-1263
Practice Address - Country:US
Practice Address - Phone:251-873-6192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL32661207R00000X
ALMD.35145207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine