Healthcare Provider Details

I. General information

NPI: 1639897432
Provider Name (Legal Business Name): ANNA GREEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 CLAIRMONT RD
DECATUR GA
30033-4004
US

IV. Provider business mailing address

626 DEKALB AVE SE APT 1321
ATLANTA GA
30312-5405
US

V. Phone/Fax

Practice location:
  • Phone: 478-984-6318
  • Fax:
Mailing address:
  • Phone: 478-984-6318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRPH033134
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: