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General NPI Number Information
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NPI Number | 1497464283
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Entity Type | Individual
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Provider Name | MONIQUE HUDSON GREEN PA (ASCP)
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Gender | Female
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 5665 PEACHTREE DUNWOODY RD
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City | ATLANTA
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State | GA
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Zip | 30342-1764
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Country | US
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Telephone | 404-449-5947
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Fax |
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Provider Business Mailing Address
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Address Line | 321 PARDUCCI TRL
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City | ATLANTA
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State | GA
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Zip | 30349-8126
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Country | US
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Telephone |
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 1149
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License Number State | GA
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