Provider Demographics
NPI:1326174327
Name:STEVEN T. GREENHAW MD PC
Entity Type:Organization
Organization Name:STEVEN T. GREENHAW MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:GREENHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-245-7070
Mailing Address - Street 1:PO BOX 3910
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-3910
Mailing Address - Country:US
Mailing Address - Phone:229-245-7070
Mailing Address - Fax:229-245-9005
Practice Address - Street 1:2704 N OAK ST BLDG G
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1767
Practice Address - Country:US
Practice Address - Phone:229-245-7070
Practice Address - Fax:229-245-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035427174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1568449981OtherNPI INDIVIDUAL
GA00494557BMedicaid
GAGRP3591Medicare ID - Type UnspecifiedMEDICARE GROUP
GA1057440001Medicare NSC
GAF31439Medicare UPIN
GA00494557BMedicaid