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NPI Code Detail

MEDICARE: DR. PHILLIP EDWARD GREEN M.D.

MEDICARE: DR. PHILLIP EDWARD GREEN M.D.
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
1207LP2900XPain Medicine (Anesthesiology) Physician17865TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639175037
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILLIP EDWARD GREEN M.D.
Provider Business Mailing Address
First Line : 6325 HUMPHREYS BLVD
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-2300
Country : US
Telephone Number : 901-522-7700
Fax Number : 901-522-2600
Provider Business Practice Location Address
First Line : 6325 HUMPHREYS BLVD
Second Line :
City : MEMPHIS
State : TN
Zip : 38120-2300
Country : US
Telephone Number : 901-522-7700
Fax Number : 901-522-2600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2005
Last Update Date : 05/15/2025

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Directions to “ DR. PHILLIP EDWARD GREEN M.D.” Practice Location

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