Basic Information
| Provider Information | |||||||||
| NPI: | 1114238912 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREER | ||||||||
| FirstName: | VERNON | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 640 | ||||||||
| Address2: | |||||||||
| City: | MCMINNVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371110640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315071223 | ||||||||
| FaxNumber: | 9315071218 | ||||||||
| Practice Location | |||||||||
| Address1: | 5736 MANCHESTER HWY | ||||||||
| Address2: | |||||||||
| City: | MORRISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373577503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9318153871 | ||||||||
| FaxNumber: | 9318153876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2010 | ||||||||
| LastUpdateDate: | 10/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 798 | TN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 10I804006 | 01 | TN | MEDICARE PTAN | OTHER | 1531083 | 05 | TN | MEDICAID |