Active NPI
Herbert Sam Greenwald Jr., M.D.
- Ophthalmology Physician
- Macon, GA
National Provider Identifier
1013135565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 011346
- Practice address
- 5067 Wellington Dr
Macon, GA 31210-4429 - Phone
- (478) 474-7430
- Fax
- (478) 474-6247
- NPI assigned
- Apr 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 011346 | GA | Primary |
Addresses
Primary practice location
5067 Wellington Dr
Macon, GA 31210-4429
Mailing address
PO Box 26700
Macon, GA 31221-6700
Phone (478) 474-7430
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AG5253199 | Other | GA | NARCOTICS LICENSE |
| 011346 | Other | GA | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011346 | GA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013135565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 26700",
"city": "MACON",
"state": "GA",
"postal_code": "312216700",
"telephone_number": "478-474-7430",
"fax_number": "478-474-6247"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5067 WELLINGTON DR",
"city": "MACON",
"state": "GA",
"postal_code": "312104429",
"telephone_number": "478-474-7430",
"fax_number": "478-474-6247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENWALD",
"first_name": "HERBERT",
"middle_name": "SAM",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "GA",
"license": "011346",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NARCOTICS LICENSE",
"identifier": "AG5253199",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "011346",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.