Healthcare Provider Details

I. General information

NPI: 1790699437
Provider Name (Legal Business Name): MARGARET GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5721 USA NORTH DRIVE
MOBILE AL
36688-0001
US

IV. Provider business mailing address

7687 BAY SHORE DR
ELBERTA AL
36530-5605
US

V. Phone/Fax

Practice location:
  • Phone: 251-979-3498
  • Fax:
Mailing address:
  • Phone: 251-979-3498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: