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General NPI Number Information
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NPI Number | 1144609215
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Entity Type | Organization
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Legal Business Name | GREEN TRANSITIONS MHT LLC
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 317 RUTH VISTA RD
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City | LEXINGTON
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State | SC
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Zip | 29073-8628
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Country | US
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Telephone | 972-616-4932
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Fax | 877-489-3949
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Provider Business Mailing Address
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Address Line | 317 RUTH VISTA RD
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City | LEXINGTON
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State | SC
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Zip | 29073-8628
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Country | US
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Telephone | 972-616-4932
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Fax | 877-489-3949
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | DONNIELLE GREEN
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Credential | DO
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Telephone | 972-616-4932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 894
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License Number State | SC
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