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General NPI Number Information
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NPI Number | 1366431025
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Entity Type | Individual
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Provider Name | VINCENT EDWARD GREEN M.D
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Gender | Male
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 300 SCUFFLETOWN RD
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-7204
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Country | US
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Telephone | 864-522-1550
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Fax |
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-522-2286
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31396
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License Number State | SC
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