Provider Demographics
NPI:1568449981
Name:GREENHAW, STEVEN THOMAS (M D)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:THOMAS
Last Name:GREENHAW
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3910
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-3910
Mailing Address - Country:US
Mailing Address - Phone:229-245-7070
Mailing Address - Fax:229-245-9005
Practice Address - Street 1:2704 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1767
Practice Address - Country:US
Practice Address - Phone:229-245-7070
Practice Address - Fax:229-245-9005
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035427207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00494557BMedicaid
GAF31439Medicare UPIN
GAGRP3591Medicare ID - Type UnspecifiedMEDICARE