Individual
DR. HERBERT SAM GREENWALD JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5067 WELLINGTON DR, MACON, GA 31210-4429
(478) 474-7430
(478) 474-6247
Mailing address
PO BOX 26700, MACON, GA 31221-6700
(478) 474-7430
(478) 474-6247
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
011346
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011346
MEDICAL LICENSE
GA
01
—
AG5253199
NARCOTICS LICENSE
GA
Enumeration date
04/22/2007
Last updated
07/08/2007
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