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General NPI Number Information
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NPI Number | 1033366364
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Entity Type | Individual
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Provider Name | JEANETTE FAITH GREEN PHD, APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 1821 CLIFTON RD NE
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City | ATLANTA
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State | GA
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Zip | 30329-4021
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Country | US
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Telephone | 800-434-7495
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Fax |
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Provider Business Mailing Address
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Address Line | 1821 CLIFTON RD NE STE 1200
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City | ATLANTA
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State | GA
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Zip | 30329-4021
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Country | US
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Telephone |
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Fax |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | RN302779
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | APRN9189741
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN302779
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | RN302799
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License Number State | GA
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