Provider Demographics
NPI:1356326557
Name:GREENE, WILLIAM GORDON (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GORDON
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 STEPHENSON AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5984
Mailing Address - Country:US
Mailing Address - Phone:912-354-4180
Mailing Address - Fax:912-303-4941
Practice Address - Street 1:529 STEPHENSON AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5984
Practice Address - Country:US
Practice Address - Phone:912-354-4180
Practice Address - Fax:912-303-4941
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0518082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA407507511BOtherPEACH STATE HEALTH PLAN
GA407507511BMedicaid
GA359001OtherWELLCARE
GAP00340705OtherRAILROAD MEDICARE
GA407507511BMedicaid
GA359001OtherWELLCARE