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General NPI Number Information
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NPI Number | 1538580659
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Entity Type | Individual
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Provider Name | ELVIS GREENE
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Gender | Male
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 12/16/2013
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Provider Practice Location Address
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Address Line | 9021 VETERANS PKWY
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City | MIDLAND
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State | GA
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Zip | 31820-3411
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Country | US
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Telephone | 706-660-9926
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 COMER AVE
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City | COLUMBUS
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State | GA
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Zip | 31904-8725
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Country | US
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Telephone | 706-596-5575
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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