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General NPI Number Information
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NPI Number | 1124528237
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Entity Type | Individual
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Provider Name | STEPHANIE NICOLE GREEN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/15/2018
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Last Update Date | 12/31/2025
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Provider Practice Location Address
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Address Line | 2060 DAN PROCTOR DR STE 2100
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City | SAINT MARYS
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State | GA
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Zip | 31558-3895
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Country | US
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Telephone | 912-882-6767
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Fax |
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Provider Business Mailing Address
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Address Line | 3172 PAXTON RD
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City | FOLKSTON
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State | GA
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Zip | 31537-9079
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Country | US
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Telephone | 912-276-0562
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN-NP231333
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License Number State | GA
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