Provider Demographics
NPI:1619556651
Name:GREENE, EBONY HOPE
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:HOPE
Last Name:GREENE
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 1:87 HAMPTON OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-2193
Mailing Address - Country:US
Mailing Address - Phone:678-396-8647
Mailing Address - Fax:
Practice Address - Street 1:87 HAMPTON OAKS DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-2193
Practice Address - Country:US
Practice Address - Phone:678-396-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20-0814Y10246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy