Basic Information
Provider Information | |||||||||
NPI: | 1649288705 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | GREER | ||||||||
FirstName: | WILLIAM | ||||||||
MiddleName: | J | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 421718 | ||||||||
Address2: |   | ||||||||
City: | GEORGETOWN | ||||||||
State: | SC | ||||||||
PostalCode: | 294424203 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8436528226 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 4040 HIGHWAY 17 | ||||||||
Address2: | SUITE 101 | ||||||||
City: | MURRELLS INLET | ||||||||
State: | SC | ||||||||
PostalCode: | 295765098 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8436528160 | ||||||||
FaxNumber: | 8436528161 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/04/2006 | ||||||||
LastUpdateDate: | 03/22/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/22/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | MD423849 | PA | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0005X | 35074 | SC | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
ID | Type | State | Issuer | Description | 3810008050 | 05 | WV |   | MEDICAID | 350747 | 05 | SC |   | MEDICAID | 2721639 | 05 | OH |   | MEDICAID |