MEDICARE: TAMERA RENEE GREEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	P021502	NC

General Provider Information

NPI Number	:	1467266130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMERA RENEE GREEN

Provider Business Mailing Address
First Line	:	276 LEIGH FARM RD APT 122
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-8139
Country	:	US
Telephone Number	:	843-437-9827
Fax Number	:

Provider Business Practice Location Address
First Line	:	276 LEIGH FARM RD APT 122
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-8139
Country	:	US
Telephone Number	:	843-437-9827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/04/2025
Last Update Date	:	02/04/2025

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Directions to “ TAMERA RENEE GREEN ” Practice Location

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