Provider Demographics
NPI:1760830947
Name:GREENWAY, ALLEN JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:JAMES
Last Name:GREENWAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37208 CLIO ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-2606
Mailing Address - Country:US
Mailing Address - Phone:586-929-6419
Mailing Address - Fax:
Practice Address - Street 1:1209 10TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5262
Practice Address - Country:US
Practice Address - Phone:810-985-8170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-30
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601007779363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant