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NPI Code Detail

MEDICARE: CHRISTOPHER GREEN

MEDICARE: CHRISTOPHER GREEN
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
1390200000XStudent in an Organized Health Care Education/Training ProgramIR60287892WA

General Provider Information

NPI Number : 1255787826
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTOPHER GREEN
Provider Business Mailing Address
First Line : 149 26TH ST NW
Second Line : APT 1206
City : ATLANTA
State : GA
Zip : 30309-2065
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 149 26TH ST NW
Second Line : APT 1206
City : ATLANTA
State : GA
Zip : 30309-2065
Country : US
Telephone Number : 731-343-2266
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2016
Last Update Date : 05/12/2016

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Directions to “ CHRISTOPHER GREEN ” Practice Location

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