Provider Demographics
NPI:1518900034
Name:GREENFIELD, DAVID B (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:GREENFIELD
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 1:5629 HWY 21 SOUTH
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326
Mailing Address - Country:US
Mailing Address - Phone:912-295-2133
Mailing Address - Fax:912-295-5924
Practice Address - Street 1:5629 HWY 21 SOUTH
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326
Practice Address - Country:US
Practice Address - Phone:912-295-2133
Practice Address - Fax:912-295-5924
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26812207P00000X
GA054567207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA085676134BMedicaid
GA085676134FMedicaid
GA085676134EMedicaid
GA10058656OtherAMERIGROUP
GA085676134CMedicaid
SC085676134FMedicaid
GA085676134GMedicaid
SCG54567Medicaid
GA085676134AMedicaid
GA085676134JHMedicaid
GAP00142406Medicare PIN
GA085676134EMedicaid
GA085676134FMedicaid
GA085676134AMedicaid
GA10058656OtherAMERIGROUP
GA93BBGTZMedicare PIN
SCI090359075Medicare PIN