MEDICARE: DR. ERIC BRENT 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	2085R0202X	Diagnostic Radiology Physician	0101239681	VA

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	:	1184646929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC BRENT GREEN M.D.

Provider Business Mailing Address
First Line	:	210 25TH AVE N
Second Line	:	SUITE 602
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1606
Country	:	US
Telephone Number	:	615-312-0612
Fax Number	:	615-312-0612

Provider Business Practice Location Address
First Line	:	210 25TH AVE N
Second Line	:	SUITE 602
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1606
Country	:	US
Telephone Number	:	615-327-4737
Fax Number	:	615-327-4737

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	04/22/2008

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