MEDICARE: WILLIAM ALEXANDER GREEN IV

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	183500000X	Pharmacist	45399	TN

General Provider Information

NPI Number	:	1497639595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM ALEXANDER GREEN IV

Provider Business Mailing Address
First Line	:	1075 PEERLESS XING NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3764
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 PEERLESS XING NW
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37312-3764
Country	:	US
Telephone Number	:	423-339-3363
Fax Number	:

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

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	08/01/2025

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