Provider Demographics
NPI:1366484560
Name:GREENE, ONAJE DADISI (MD)
Entity type:Individual
Prefix:
First Name:ONAJE
Middle Name:DADISI
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:119 AMBULANCE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-836-9326
Mailing Address - Fax:770-836-9358
Practice Address - Street 1:705 DIXIE ST
Practice Address - Street 2:SUITE 401
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3818
Practice Address - Country:US
Practice Address - Phone:770-836-9326
Practice Address - Fax:770-836-9358
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA057079207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA346632641GMedicaid
GA511I060280OtherMEDICARE PTAN