Harry Mark Greene, DMD
Individual provider Active NPI Dentist · Tallapoosa, GA
NPI 1386773240 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1386773240
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 8271 (GA)
- Practice address
- 1196 Pine Grove Rd
Tallapoosa, GA 30176 - Phone
- (770) 574-2812
- Fax
- (770) 574-5020
- NPI assigned
- Mar 5, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8271 | GA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Loynes Dental Care, LLC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8271 | GA | Yes |
Addresses
Primary practice location
1196 Pine Grove Rd
Tallapoosa, GA 30176
Mailing address
PO Box 386
Tallapoosa, GA 30176
Phone (770) 574-2812
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00046241A | Medicaid | GA |
Other providers in Tallapoosa, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.