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General NPI Number Information
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NPI Number | 1033143714
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Entity Type | Individual
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Provider Name | BRIAN A GREEN MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 1661 INTERNATIONAL PLACE DRIVE SUITE 350
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City | MEMPHIS
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State | TN
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Zip | 38120
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Country | US
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Telephone | 901-685-2696
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Fax | 901-682-9747
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Provider Business Mailing Address
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Address Line | 1661 INTERNATIONAL PLACE DRIVE SUITE 350
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City | MEMPHIS
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State | TN
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Zip | 38120
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Country | US
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Telephone | 901-685-2696
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Fax | 901-682-9747
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 49303
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2004005488
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 2085P0229X
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Taxonomy Name | Pediatric Radiology Physician
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License Number | MD0000046433
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License Number State | TN
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