Healthcare Provider Details

I. General information

NPI: 1205740644
Provider Name (Legal Business Name): PAMELA GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 CHERRY ST APT 108
MACON GA
31201-6312
US

IV. Provider business mailing address

2114 N FLAMINGO RD # 1257
PEMBROKE PINES FL
33028-3501
US

V. Phone/Fax

Practice location:
  • Phone: 770-715-8469
  • Fax:
Mailing address:
  • Phone: 770-715-8469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95269757
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN293971
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: