MEDICARE: SUSAN A GREENE APRN-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
1	363LG0600X	Gerontology Nurse Practitioner	100566	GA
2	363LG0600X	Gerontology Nurse Practitioner	5023924	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	83-02313	OTHER	GA	EVERCARE

General Provider Information

NPI Number	:	1982631040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN A GREENE APRN-BC

Provider Business Mailing Address
First Line	:	1351 OLD MOBILE RD
Second Line	:
City	:	MC CAYSVILLE
State	:	GA
Zip	:	30555-1950
Country	:	US
Telephone Number	:	706-492-5274
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 BOMBAY LN
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30076-5829
Country	:	US
Telephone Number	:	770-664-1920
Fax Number	:	888-388-9622

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	03/25/2026

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Directions to “ SUSAN A GREENE APRN-BC” Practice Location

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