Healthcare Provider Details

I. General information

NPI: 1942838875
Provider Name (Legal Business Name): DR. JOHN ALVIN GREEN III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 S UNIVERSITY BLVD
MOBILE AL
36608-3271
US

IV. Provider business mailing address

PO BOX 21595
BELFAST ME
04915-4112
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7870
  • Fax: 251-460-7923
Mailing address:
  • Phone: 251-318-2678
  • Fax: 251-405-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2783
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2738
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: