Healthcare Provider Details

I. General information

NPI: 1699725671
Provider Name (Legal Business Name): LINDA HAYNIE GREEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4103 STEMLEY BRIDGE RD
PELL CITY AL
35128-7519
US

IV. Provider business mailing address

4103 STEMLEY BRIDGE RD
PELL CITY AL
35128-7519
US

V. Phone/Fax

Practice location:
  • Phone: 205-338-7662
  • Fax: 205-884-8862
Mailing address:
  • Phone: 205-338-7662
  • Fax: 205-884-8862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC-4828
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number26919
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: