Provider Demographics
NPI:1942232681
Name:GREENE, MICHAEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:GREENE
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 1:5354 REYNOLDS ST STE 424
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6011
Mailing Address - Country:US
Mailing Address - Phone:912-819-5999
Mailing Address - Fax:912-819-5980
Practice Address - Street 1:5354 REYNOLDS ST STE 424
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6011
Practice Address - Country:US
Practice Address - Phone:912-819-5999
Practice Address - Fax:912-819-5980
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000473943IMedicaid
GA08BBRSQOtherUNKNOWN
GAGRP7284OtherPTAN
GAGRP7284Medicare ID - Type UnspecifiedGROUP
GA08BBRSQOtherUNKNOWN
GAF04441Medicare UPIN
GA000473943IMedicaid