Healthcare Provider Details

I. General information

NPI: 1154061349
Provider Name (Legal Business Name): NATALIE GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MEDICAL PKWY STE 100
GREER SC
29650-2458
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-9200
  • Fax: 864-797-9245
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number87621
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: