Provider Demographics
NPI:1194007971
Name:GREENWAY, MARY JO (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:GREENWAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:291 JOHNSON GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MIDVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30441-4744
Mailing Address - Country:US
Mailing Address - Phone:478-763-3851
Mailing Address - Fax:678-827-0711
Practice Address - Street 1:117 KITE RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3231
Practice Address - Country:US
Practice Address - Phone:478-289-1150
Practice Address - Fax:478-289-1199
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN144604363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner