MEDICARE: TAMEKA 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0948	GA

General Provider Information

NPI Number	:	1659151835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMEKA GREEN

Provider Business Mailing Address
First Line	:	1441 WOODMONT LN NW # 157
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1745 PHOENIX BLVD STE 305
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-5534
Country	:	US
Telephone Number	:	678-575-3611
Fax Number	:

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

Provider Enumeration Date	:	10/04/2023
Last Update Date	:	10/04/2023

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Directions to “ TAMEKA GREEN ” Practice Location

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