Provider Demographics
NPI:1083260335
Name:GREENE, CECELIA SANTANA (NP)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:SANTANA
Last Name:GREENE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SANTANA
Other - Middle Name:
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 E WOOD ST STE 401
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23134363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCG1985019OtherMEDICARE PIN
SCSCG1989068OtherMEDICARE PIN
SCG198J577OtherMEDICARE PIN
SCNP6172Medicaid