Jerry George Greeson, MED, LAT, ATC

Primary specialty

Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X

License

AT0646 Issued in TX

Practice address

2239 Walker Ave BLDG 5570
Jbsa Lackland, TX 78236-5632

Phone

(210) 365-8316

NPI assigned

Oct 27, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603756800000",
    "number": "1831799238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24526 DREW GAP",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782552284",
            "telephone_number": "210-365-8316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2239 WALKER AVE BLDG 5570",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365632",
            "telephone_number": "210-365-8316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREESON",
        "first_name": "JERRY",
        "middle_name": "GEORGE",
        "credential": "MED, LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-10-27",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "TX",
            "license": "AT0646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Nicole Goyet, PA-C
• Stephen Scott Grabner II
• Palmira R Granado, LCSW
• Jay Douglas Graver, DMD
• Abigail Greenwell, MD
• Bryce M Griffin, DPT
• William Arthur Grosdidier
• Jordan Grove, MD
• Mary Teju Guest, M.D.
• Daniel K Gullekson, OD

• Sports Medicine (Emergency Medicine) Physician in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• Sports Medicine (Emergency Medicine) Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.