Provider Demographics
NPI:1225579584
Name:GREENAN, GARRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:GARRETT
Middle Name:
Last Name:GREENAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11301 CARMEL COMMONS BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-5305
Mailing Address - Country:US
Mailing Address - Phone:704-372-7974
Mailing Address - Fax:704-970-4746
Practice Address - Street 1:705 GRIFFITH ST STE 205
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-9307
Practice Address - Country:US
Practice Address - Phone:704-372-7974
Practice Address - Fax:704-372-8201
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2020011722207RG0100X
NC2023-01019207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2021045755OtherPERMANENT MISSOURI STATE LICENSE
NC2023-01019OtherNCMB