Provider Demographics
NPI:1578058624
Name:GREENWOOD, FANNIETRA
Entity Type:Individual
Prefix:
First Name:FANNIETRA
Middle Name:
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3265 W SARAZENS CIR STE 204
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-0806
Mailing Address - Country:US
Mailing Address - Phone:901-334-7874
Mailing Address - Fax:901-339-6167
Practice Address - Street 1:3265 W SARAZENS CIR STE 204
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-0806
Practice Address - Country:US
Practice Address - Phone:901-334-7874
Practice Address - Fax:901-339-6167
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care