MEDICARE: MARSHA GREEN RN

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	163W00000X	Registered Nurse	RN175200	GA

General Provider Information

NPI Number	:	1689178386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHA GREEN RN

Provider Business Mailing Address
First Line	:	1385 LAKEBOAT WAY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8936
Country	:	US
Telephone Number	:	404-492-2098
Fax Number	:

Provider Business Practice Location Address
First Line	:	1385 LAKEBOAT WAY SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8936
Country	:	US
Telephone Number	:	404-492-2098
Fax Number	:

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

Provider Enumeration Date	:	03/19/2018
Last Update Date	:	03/19/2018

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