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NPI Code Detail

MEDICARE: RICHARD ALLEN GREEN PMHNP-BC

MEDICARE: RICHARD ALLEN GREEN PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerRN246976GA

General Provider Information

NPI Number : 1659724631
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD ALLEN GREEN PMHNP-BC
Provider Business Mailing Address
First Line : 7487 OBRIEN LOOP
Second Line :
City : FORT BENNING
State : GA
Zip : 31905-2761
Country : US
Telephone Number : 229-942-9870
Fax Number :
Provider Business Practice Location Address
First Line : BLDG 4200 WILSON HALL
Second Line :
City : FORT BENNING
State : GA
Zip : 31905
Country : US
Telephone Number : 706-626-5904
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2016
Last Update Date : 12/11/2025

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