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General NPI Number Information
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NPI Number | 1275485849
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Entity Type | Individual
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Provider Name | JENNIFER CHRISTINE GREEN RN
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Gender | Female
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Dates
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Enumeration Date | 02/13/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 1859 REDFERN RD
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City | DACULA
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State | GA
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Zip | 30019-2651
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Country | US
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Telephone | 347-251-1583
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Fax |
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Provider Business Mailing Address
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Address Line | 1859 REDFERN RD
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City | DACULA
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State | GA
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Zip | 30019-2651
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Country | US
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Telephone | 347-251-1583
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN324103
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 660540-1
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License Number State | NY
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