Healthcare Provider Details

I. General information

NPI: 1508157371
Provider Name (Legal Business Name): ALISON LOUISE GREEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALISON LOUISE LEE MD

II. Dates (important events)

Enumeration Date: 04/27/2011
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MCLAIN ST STE G
NEWPORT AR
72112-3550
US

IV. Provider business mailing address

1200 MCLAIN ST STE G
NEWPORT AR
72112-3550
US

V. Phone/Fax

Practice location:
  • Phone: 870-523-0193
  • Fax: 978-525-2342
Mailing address:
  • Phone: 870-523-0193
  • Fax: 978-525-2342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE7874
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number266537
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: