Healthcare Provider Details

I. General information

NPI: 1811044795
Provider Name (Legal Business Name): GARLAND GARY GREEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 PICARDY AVE
BATON ROUGE LA
70809-3685
US

IV. Provider business mailing address

8401 PICARDY AVE
BATON ROUGE LA
70809-3685
US

V. Phone/Fax

Practice location:
  • Phone: 225-308-0247
  • Fax: 225-308-0249
Mailing address:
  • Phone: 225-308-0247
  • Fax: 225-308-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number201586
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number201586
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: