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General NPI Number Information
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NPI Number | 1639520174
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Entity Type | Individual
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Provider Name | AMIE L GREEN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 14 RIVERBEND DR SW
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City | ROME
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State | GA
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Zip | 30161-6066
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Country | US
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Telephone | 706-234-0094
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Fax | 877-761-3771
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Provider Business Mailing Address
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Address Line | 114 TOWNPARK DR NW SUITE 240
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City | KENNESAW
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State | GA
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Zip | 30144-3715
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Country | US
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Telephone | 770-485-3723
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN205078
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License Number State | GA
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