Individual
MALLORIE BOSWELL GREENWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2700 MAY RIVER XING STE 100, BLUFFTON, SC 29910-9732
(843) 985-2520
Mailing address
PO BOX 23321, NEW YORK, NY 10087-4321
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4904
TENNESSEE DEPARTMENT OF HEALTH
TN
Enumeration date
01/25/2022
Last updated
10/23/2024
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