Provider Demographics
NPI:1609875467
Name:GREER, JACK EWELL (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:EWELL
Last Name:GREER
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 1:901 RIVERFRONT PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2193
Mailing Address - Country:US
Mailing Address - Phone:423-698-8981
Mailing Address - Fax:423-697-7109
Practice Address - Street 1:901 RIVERFRONT PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2193
Practice Address - Country:US
Practice Address - Phone:423-698-8981
Practice Address - Fax:423-697-7109
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047438207Y00000X
TNMD0000026020207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00815328AMedicaid
TN1040185OtherUNITED HLTHCARE
TN3126040OtherBC/BS TN
G11401Medicare UPIN
TN3819960Medicare ID - Type Unspecified