Provider Demographics
NPI:1013913474
Name:GREENWELL, THOMAS DAVID JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DAVID
Last Name:GREENWELL
Suffix:JR
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 1:7606 CHAPEL CREEK PKWY N
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-2848
Mailing Address - Country:US
Mailing Address - Phone:901-230-2869
Mailing Address - Fax:
Practice Address - Street 1:7606 CHAPEL CREEK PKWY N
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-2848
Practice Address - Country:US
Practice Address - Phone:901-230-2869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000012807174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3010851Medicare ID - Type UnspecifiedGERMANTOWN MEDICARE #
TN3010850Medicare ID - Type UnspecifiedHUMPHREYS MEDICARE #
TNA97506Medicare UPIN