Basic Information
Provider Information
NPI: 1487145322
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GREER
FirstName: JEREMY
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 103 W BROADWAY AVE
Address2:  
City: MARYVILLE
State: TN
PostalCode: 378014703
CountryCode: US
TelephoneNumber: 8652731752
FaxNumber: 8652731755
Practice Location
Address1: 232 ASSOCIATES BLVD
Address2:  
City: ALCOA
State: TN
PostalCode: 377011943
CountryCode: US
TelephoneNumber: 8652386450
FaxNumber: 8652386451
Other Information
ProviderEnumerationDate: 05/26/2018
LastUpdateDate: 07/18/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/18/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207N00000X64975TNY Allopathic & Osteopathic PhysiciansDermatology 

No ID Information.


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