Provider Demographics
NPI:1821032285
Name:GREENE, JONATHAN F (DO)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:F
Last Name:GREENE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:103 W BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4703
Mailing Address - Country:US
Mailing Address - Phone:865-273-1752
Mailing Address - Fax:865-273-1755
Practice Address - Street 1:720 FOOTHILLS MALL DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-3519
Practice Address - Country:US
Practice Address - Phone:865-342-8100
Practice Address - Fax:865-342-8110
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN1700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3319672Medicaid
TN3319672Medicare PIN
TN4129777OtherBCBST
TN3319672Medicare PIN