Provider Demographics
NPI:1457492175
Name:GREENE, QUINCY JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:QUINCY
Middle Name:JUSTIN
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:730 MALCOLM BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CONNELLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28612-8079
Mailing Address - Country:US
Mailing Address - Phone:828-580-2250
Mailing Address - Fax:828-580-2252
Practice Address - Street 1:730 MALCOLM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CONNELLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28612-8079
Practice Address - Country:US
Practice Address - Phone:828-580-2250
Practice Address - Fax:828-580-2252
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2009-01071208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1457492175Medicaid
NC2327875Medicare PIN