Provider Demographics
NPI:1124076237
Name:GREENAWAY, DAVID SCOTT (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:GREENAWAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 MARSH LANDING BLVD
Mailing Address - Street 2:UNIT 6
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-7215
Mailing Address - Country:US
Mailing Address - Phone:904-473-7890
Mailing Address - Fax:
Practice Address - Street 1:62 LENOX POINTE NE
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-7409
Practice Address - Country:US
Practice Address - Phone:904-330-8204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8690103TC0700X
GAPSY003045103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA555802958AMedicaid