Provider Demographics
NPI:1609569136
Name:GREER, TY HAYDEN
Entity Type:Individual
Prefix:
First Name:TY
Middle Name:HAYDEN
Last Name:GREER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 PRIVATE ROAD 3151 APT 9
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7044
Mailing Address - Country:US
Mailing Address - Phone:901-334-7030
Mailing Address - Fax:
Practice Address - Street 1:84 DORMITORY ROW WEST
Practice Address - Street 2:UNIVERSITY, MS 38677
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38677
Practice Address - Country:US
Practice Address - Phone:662-915-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program