Basic Information
| Provider Information | |||||||||
| NPI: | 1609142041 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENBERG | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | ADAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 979 E 3RD ST STE C735 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374033310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237789101 | ||||||||
| FaxNumber: | 4237789190 | ||||||||
| Practice Location | |||||||||
| Address1: | 979 E 3RD ST STE C735 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237789101 | ||||||||
| FaxNumber: | 4237789190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2012 | ||||||||
| LastUpdateDate: | 07/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 51072 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 51072 | 01 | TN | TENNESSEE MEDICAL LICENSE | OTHER |