Healthcare Provider Details

I. General information

NPI: 1942111406
Provider Name (Legal Business Name): LOIS GREEN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 FAIRMONT PARK CT
DACULA GA
30019-6550
US

IV. Provider business mailing address

2626 FAIRMONT PARK CT
DACULA GA
30019-6550
US

V. Phone/Fax

Practice location:
  • Phone: 770-800-1122
  • Fax:
Mailing address:
  • Phone: 770-800-1122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: