Doctor Name: | MR. JAMES ELLIS GREEN |
NPI Number: | 1871709840 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | G027200 |
Business Practice Address: | 526 Pearl Nix Parkway Suite #103 Gainesville, GA - 30501 |
Business Phone Number: | 7705357978 |
Business Fax Number: | 7705358050 |
Mailing Address: | Po Box 7970, GAINESVILLE |
State: | GA |
Postal Code: | 30504 |
Phone Number: | 7705357978 |
Fax Number: | 7705358050 |
NPI Enumeration Date: | 05/15/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G027200 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |