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General NPI Number Information
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NPI Number | 1275293656
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Entity Type | Organization
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Legal Business Name | EGREEN ENTERPRISES, INC
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 3150 GOLF RIDGE BLDVD SUITE 101
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City | DOUGLASVILLE
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State | GA
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Zip | 30135
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Country | US
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Telephone | 770-990-3335
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Fax |
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Provider Business Mailing Address
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Address Line | 5072 CHAPEL LAKE CIRCLE
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City | DOUGLASVILLE
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State | GA
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Zip | 30135
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Country | US
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Telephone | 716-308-6266
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | EDIE A. SWAGGARD-GREEN
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Credential | R, PH
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Telephone | 716-308-6266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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