Healthcare Provider Details

I. General information

NPI: 1700721099
Provider Name (Legal Business Name): MRS. CHRISTEN L GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 DIPTERA LN
FAIRBURN GA
30213-6509
US

IV. Provider business mailing address

4700 DIPTERA LN
FAIRBURN GA
30213-6509
US

V. Phone/Fax

Practice location:
  • Phone: 281-901-4717
  • Fax:
Mailing address:
  • Phone: 470-629-2868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: