Healthcare Provider Details

I. General information

NPI: 1790640050
Provider Name (Legal Business Name): ROSA GREEN DAVIS NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 MARION DR
MATTHEWS NC
28105-2639
US

IV. Provider business mailing address

625 MARION DR
MATTHEWS NC
28105-2639
US

V. Phone/Fax

Practice location:
  • Phone: 336-829-6760
  • Fax:
Mailing address:
  • Phone: 336-829-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-4209682
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: