Provider Demographics
NPI:1154670958
Name:GREENWOOD, JOSEPH SPENCER (RD, LD/N)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SPENCER
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 WINDRUSH LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4537
Mailing Address - Country:US
Mailing Address - Phone:904-910-6121
Mailing Address - Fax:
Practice Address - Street 1:5150 TIMUQUANA RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-8959
Practice Address - Country:US
Practice Address - Phone:904-253-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6286133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered