Healthcare Provider Details

I. General information

NPI: 1669486973
Provider Name (Legal Business Name): DRS. GREEN, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK BLVD SUITE 450W
BRISTOL TN
37620-7430
US

IV. Provider business mailing address

1 MEDICAL PARK BLVD SUITE 450W
BRISTOL TN
37620-7430
US

V. Phone/Fax

Practice location:
  • Phone: 423-968-3713
  • Fax: 423-968-7352
Mailing address:
  • Phone: 423-968-3713
  • Fax: 423-968-7352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number009980
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number011243
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number038379
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number023958
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number034106
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number015559
License Number StateTN

VIII. Authorized Official

Name: MS. DONNA T. OSTERMEYER
Title or Position: OFFICE MANAGER
Credential:
Phone: 423-764-1084