Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2019-00515 | NC |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MT188734 | PA |
NPI | 1023227626 |
---|---|
Provider Name | Dr. Jewel D Greywoode |
First Address | Charlotte, NC 28210-3256 |
Second Address | Charlotte, NC 28210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 28/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023227626 | (05) | NC |