MEDICARE: DR. RONYA GREEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	P1639	TX
2	207Q00000X	Family Medicine Physician	60381	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174834824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONYA GREEN M.D.

Provider Business Mailing Address
First Line	:	397 WALLACE RD STE 100
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-8025
Country	:	US
Telephone Number	:	615-834-6166
Fax Number	:	615-781-9755

Provider Business Practice Location Address
First Line	:	397 WALLACE RD STE 100
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37211-8025
Country	:	US
Telephone Number	:	615-834-6166
Fax Number	:	615-781-9755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	01/31/2022

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