Basic Information
| Provider Information | |||||||||
| NPI: | 1033881727 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENWAY | ||||||||
| FirstName: | SHIRLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9376 COUNTY ROAD 29 | ||||||||
| Address2: | |||||||||
| City: | CENTRE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359603123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789884872 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 REDMOND RD NW | ||||||||
| Address2: | |||||||||
| City: | ROME | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301651415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7062910291 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2021 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | RN269138 | GA | Y | Nursing Service Providers | Registered Nurse | Critical Care Medicine |
No ID Information.