Doctor Name: | JEAN GREEN |
NPI Number: | 1114337359 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | RN174038 |
Business Practice Address: | 232 Crepe Myrtle Cir Ocilla, GA - 317743348 |
Business Phone Number: | 2293256068 |
Business Fax Number: | |
Mailing Address: | 232 Crepe Myrtle Cir, OCILLA |
State: | GA |
Postal Code: | 317743348 |
Phone Number: | 2293256068 |
Fax Number: | |
NPI Enumeration Date: | 04/28/2014 |
NPI Last Update Date: | 04/28/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WM0705X |
License Number: | RN174038 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Medical-Surgical |
Taxonomy Definition: |