Healthcare Provider Details

I. General information

NPI: 1760863005
Provider Name (Legal Business Name): CAIN SANDERS GREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2015
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COURTENAY DR # DRIVE226
CHARLESTON SC
29425-8911
US

IV. Provider business mailing address

25 COURTENAY DR # DRIVE226
CHARLESTON SC
29425-8911
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-9271
  • Fax:
Mailing address:
  • Phone: 843-792-9271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME150345
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number92958
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number92958
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0000056462
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0000056462
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME150345
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: