Provider Demographics
NPI:1013721398
Name:GREENE, CHARNISE (LMT)
Entity type:Individual
Prefix:
First Name:CHARNISE
Middle Name:
Last Name:GREENE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 HUNTERS HILL DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1614
Mailing Address - Country:US
Mailing Address - Phone:678-492-2736
Mailing Address - Fax:
Practice Address - Street 1:3429 HUNTERS HILL DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-1614
Practice Address - Country:US
Practice Address - Phone:678-492-2736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT015259225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist