Healthcare Provider Details

I. General information

NPI: 1508797184
Provider Name (Legal Business Name): JESSI GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1826 VETERANS BLVD
DUBLIN GA
31021-3631
US

IV. Provider business mailing address

1880 DUBLIN EASTMAN RD
DEXTER GA
31019-4007
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-1210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number197256
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: