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General NPI Number Information
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NPI Number | 1619030012
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Entity Type | Individual
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Provider Name | VIRGINIA LITTLE GREEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 350 W WOODROW WILSON AVE JACKSON MEDICAL MALL, SUITE 454
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City | JACKSON
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State | MS
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Zip | 39213-7681
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Country | US
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Telephone | 601-987-3965
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Fax | 601-987-4176
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Provider Business Mailing Address
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Address Line | PO BOX 1700
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City | JACKSON
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State | MS
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Zip | 39215-1700
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Country | US
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Telephone | 601-987-3965
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Fax | 601-987-5560
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 10098
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License Number State | MS
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