Individual
GREGORY CLARK GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
101 E BLOUNT AVE STE 800, KNOXVILLE, TN 37920-1669
(865) 632-5900
(865) 637-2114
Mailing address
9125 CROSS PARK DR STE 200, KNOXVILLE, TN 37923-4563
(865) 632-5900
(865) 637-2114
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA400
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3046774
BCBSTN
TN
05
—
3666163
—
TN
Enumeration date
10/11/2006
Last updated
06/29/2020
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