Provider Demographics
NPI:1629129119
Name:GREENVILLE FAMILY DOCTORS, PA
Entity Type:Organization
Organization Name:GREENVILLE FAMILY DOCTORS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUENTIN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:MEWBORN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-752-7133
Mailing Address - Street 1:800 MOYE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3777
Mailing Address - Country:US
Mailing Address - Phone:252-752-7133
Mailing Address - Fax:252-752-6120
Practice Address - Street 1:800 MOYE BLVD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3777
Practice Address - Country:US
Practice Address - Phone:252-752-7133
Practice Address - Fax:252-752-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-13
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901678Medicaid
NC230285OtherMEDICARE PTAN