Provider Demographics
NPI:1558649103
Name:GREYSTONE INTERNAL MEDICINE - BROOKWOOD, L.L.C.
Entity Type:Organization
Organization Name:GREYSTONE INTERNAL MEDICINE - BROOKWOOD, L.L.C.
Other - Org Name:GREYSTONE INTERNAL MEDICINE - BROOKWOOD, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL CFO, TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-265-5009
Mailing Address - Street 1:4902 VALLEYDALE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4613
Mailing Address - Country:US
Mailing Address - Phone:205-980-8099
Mailing Address - Fax:205-980-2606
Practice Address - Street 1:101 MISSIONARY RDG
Practice Address - Street 2:SUITE 200
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-5202
Practice Address - Country:US
Practice Address - Phone:205-995-2260
Practice Address - Fax:205-980-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
102G701845Medicare PIN