MEDICARE: DR. WHITNEY ALLURA GREEN MD

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	208D00000X	General Practice Physician	66001	TN

General Provider Information

NPI Number	:	1265061162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WHITNEY ALLURA GREEN MD

Provider Business Mailing Address
First Line	:	1ST FLOOR CLINIC MALL 2817 ROCK MERRITT AVE
Second Line	:
City	:	FORT LIBERTY
State	:	NC
Zip	:	28310-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1ST FLOOR CLINIC MALL
Second Line	:	2817 ROCK MERRITT AVE
City	:	FORT LIBERTY
State	:	NC
Zip	:	38103-3438
Country	:	US
Telephone Number	:	910-907-8500
Fax Number	:

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

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	11/29/2023

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