Individual
MR. GABRIEL GUSTAVO GREENE I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6473 KINGSTON PIKE STE 6473, KNOXVILLE, TN 37919-4832
(616) 459-4171
Mailing address
PO BOX 207830, DALLAS, TX 75320-7830
(888) 412-2649
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4965
TN
Other
Enumeration date
01/19/2022
Last updated
02/19/2025
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