1215921945 NPI number — DR. MICHAEL S GREER M.D.

Table of content: DR. ANDREW HOLDAWAY MD (NPI 1508168824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215921945 NPI number — DR. MICHAEL S GREER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREER
Provider First Name:
MICHAEL
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215921945
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
979 E 3RD ST
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37403-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-267-0466
Provider Business Mailing Address Fax Number:
423-778-8168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2108 E 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37404-2600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-267-0466
Provider Business Practice Location Address Fax Number:
423-778-8168
Provider Enumeration Date:
09/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  MD12306 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208600000X , with the licence number: MD12306 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2606233 001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 62165877412 . This is a "JDH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 890661T , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q002546 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00345716B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 47561 . This is a "BCBS OF TN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1740068 . This is a "UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008701940 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020041423 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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