MEDICARE: PATRICK GREEN MD

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	111N00000X	Chiropractor	824147584	GA

General Provider Information

NPI Number	:	1710485719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK GREEN MD

Provider Business Mailing Address
First Line	:	5725 MELANIE TRL
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30349-2803
Country	:	US
Telephone Number	:	866-860-1127
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W PEACHTREE ST NW STE 4-672
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-3536
Country	:	US
Telephone Number	:	866-860-1127
Fax Number	:

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

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	01/25/2018

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