Healthcare Provider Details

I. General information

NPI: 1518744192
Provider Name (Legal Business Name): LAUREN ELIZABETH GREEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2093 HENRY TECKLENBURG DR STE 300E
CHARLESTON SC
29414-5743
US

IV. Provider business mailing address

PO BOX 632709
CINCINNATI OH
45263-2709
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2011
  • Fax: 843-606-7991
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5040
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: