Provider Demographics
NPI:1548610967
Name:GREENLEE, JASON RICHARD (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:RICHARD
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:911 W HENDERSON ST STE 110
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2700
Practice Address - Country:US
Practice Address - Phone:704-633-9441
Practice Address - Fax:704-637-9006
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022671208800000X
NC2021-02014208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty