Healthcare Provider Details

I. General information

NPI: 1275252587
Provider Name (Legal Business Name): GEORGIA N GREEN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 09/25/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14205 ROCKY BRIAR LN
ROSHARON TX
77583-2081
US

IV. Provider business mailing address

14205 ROCKY BRIAR LN
ROSHARON TX
77583-2081
US

V. Phone/Fax

Practice location:
  • Phone: 832-338-4070
  • Fax:
Mailing address:
  • Phone: 832-338-4070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: