Provider Demographics
NPI:1982883468
Name:GREENE, MARCELLA JUNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCELLA
Middle Name:JUNE
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 52948
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2948
Mailing Address - Country:US
Mailing Address - Phone:865-306-5675
Mailing Address - Fax:865-584-7712
Practice Address - Street 1:7557A DANNAHER DR, SUITE 110
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849
Practice Address - Country:US
Practice Address - Phone:865-938-8121
Practice Address - Fax:865-212-5561
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN MD47192208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525259Medicaid
103I028130Medicare PIN