Provider Demographics
NPI:1396813838
Name:GREENBAUM, ADAM B (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:B
Last Name:GREENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EMORY HEALTHCARE 1364 CLIFTON RD NE SUITE D422
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-0001
Mailing Address - Country:US
Mailing Address - Phone:404-712-7667
Mailing Address - Fax:404-712-5622
Practice Address - Street 1:EMORY UNIVERSITY HOSPITAL 1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:313-916-9106
Practice Address - Fax:313-916-1249
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI059304207RC0000X, 207R00000X
GA080063207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
060H264410OtherBLUE CROSS-BLUE CROSS
MI410065910Medicaid
AG059304OtherCHAMPUS-CHAMPUS
AG059304OtherCOMMERCIAL-COMMERCIAL NUMBER