MEDICARE: MS. CHARLOTTE DAWN LING 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
1	183500000X	Pharmacist	16494	TN

General Provider Information

NPI Number	:	1639422942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARLOTTE DAWN LING GREEN

Provider Business Mailing Address
First Line	:	3152 PARKWAY
Second Line	:	#13-103
City	:	PIGEON FORGE
State	:	TN
Zip	:	37863-3340
Country	:	US
Telephone Number	:	865-296-0818
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 NEW HARVEST LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-7000
Country	:	US
Telephone Number	:	865-291-0087
Fax Number	:

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

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	10/24/2012

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