Provider Demographics
NPI:1770132540
Name:GREENE, LEONARD GERALD JR
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:GERALD
Last Name:GREENE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 FAIRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-6100
Mailing Address - Country:US
Mailing Address - Phone:706-284-9354
Mailing Address - Fax:
Practice Address - Street 1:3825 FAIRINGTON DR
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-6100
Practice Address - Country:US
Practice Address - Phone:706-284-9354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider