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NPI Code Detail

MEDICARE: TIMOTHY GREEN PA

MEDICARE: TIMOTHY GREEN PA
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
1363A00000XPhysician Assistant101971NC

General Provider Information

NPI Number : 1356324537
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIMOTHY GREEN PA
Provider Business Mailing Address
First Line : PO BOX 19305
Second Line :
City : CHARLOTTE
State : NC
Zip : 28219-9305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 181 DANIEL RD
Second Line : STE A
City : FOREST CITY
State : NC
Zip : 28043-7151
Country : US
Telephone Number : 828-287-9504
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2005
Last Update Date : 04/06/2022

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Directions to “ TIMOTHY GREEN PA” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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