Individual
JACOB WILLIAM GREENWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1120 15TH ST # BP4109, AUGUSTA, GA 30912-0006
(706) 721-4307
Mailing address
1120 15TH ST # BP4109, AUGUSTA, GA 30912-0006
(706) 721-4307
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
17411
GA
Other
Enumeration date
05/05/2025
Last updated
05/05/2025
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