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General NPI Number Information
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NPI Number | 1518439918
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Entity Type | Organization
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Legal Business Name | GREEN HEALTH
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Dates
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Enumeration Date | 12/23/2018
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Last Update Date | 01/19/2020
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Provider Practice Location Address
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Address Line | 2004 AIRPORT RD SW STE 212
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City | HUNTSVILLE
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State | AL
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Zip | 35801-5848
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Country | US
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Telephone | 256-784-7336
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Fax |
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Provider Business Mailing Address
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Address Line | 2004 AIRPORT RD SW STE 212
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City | HUNTSVILLE
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State | AL
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Zip | 35801-5848
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Country | US
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Telephone | 256-784-7336
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. TYLER GREEN
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Credential | MD
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Telephone | 256-651-4685
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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 |
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License Number State |
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