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DR. CLYDE O. GREEN MD NPI 1417178187


NPI Information

NPI: 1417178187
Provider Name: DR. CLYDE O. GREEN, MD
Classification: Family Medicine - 207Q00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
841 MULBERRY ST
MACON, GA
ZIP 31201
Phone: (478) 741-6554
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DR. Clyde O. Green, MD is a family medicine in Macon, GA with 38 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Clyde O. Green, MD NPI is 1417178187. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: HOWARD UNIVERSITY COLLEGE OF MEDICINE
Graduation Year:1986

The provider's business location address is:

841 MULBERRY ST
MACON, GA
ZIP 31201-756
Phone: (478) 741-6554
Fax: (478) 743-7052

The NPI 1417178187 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 5/1/2007 and was last updated on 1/21/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207QH0002XFamily MedicineHospice and Palliative Medicine30072GEORGIANo
2207Q00000XFamily Medicine30072GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1157763302OTHERGEORGIAWORKERS COMP
2508457OTHERGEORGIABLUE CROSS BLUE SHIELD
3080083715MEDICARE ID-TYPE UNSPECIFIEDGEORGIARAILROAD
4D45482GRE00OTHERGEORGIASECURE CHOICE HEALTH
500358432 D, E, F, JMEDICAIDGEORGIA
6157763301OTHERGEORGIAWORKERS COMP
708BDJXLMEDICARE ID-TYPE UNSPECIFIEDGEORGIA
8D45482MEDICARE UPINGEORGIA
9105116OTHERGEORGIAPEACH STATE
101451889OTHERGEORGIAUNITED HEALTH CARE
11324341OTHERGEORGIAWELLCARE
12157763300OTHERGEORGIAWORKER COMP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.