Provider Demographics
NPI:1407857477
Name:GREENWALD, COREY S (MD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:S
Last Name:GREENWALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2711 IRVIN WAY
Mailing Address - Street 2:SUITE 211
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-5405
Mailing Address - Country:US
Mailing Address - Phone:404-501-0001
Mailing Address - Fax:404-501-0023
Practice Address - Street 1:2711 IRVIN WAY
Practice Address - Street 2:SUITE 211
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5405
Practice Address - Country:US
Practice Address - Phone:404-501-0001
Practice Address - Fax:404-501-0023
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0411302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000703293DMedicaid
GA000703293BMedicaid
GA000703293CMedicaid
GA000703293AMedicaid
GAF81945Medicare UPIN
GA000703293AMedicaid