DR. KIMBERLY J GREEN D.O NPI 1720174873

NPI Information

NPI: 1720174873
Provider Name: DR. KIMBERLY J GREEN, D.O
Classification: General Practice - 208D00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
1090 CAMBRIDGE SQ
SUITE A
ALPHARETTA, GA
ZIP 30009
Phone: (770) 754-9880
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DR. Kimberly J Green, D.O is a general practice in Alpharetta, GA with 24 years of experience. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee DR. Kimberly J Green, D.O NPI is 1720174873. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
Graduation Year:2000

The provider's business location address is:

1090 CAMBRIDGE SQ
SUITE A
ALPHARETTA, GA
ZIP 30009-875
Phone: (770) 754-9880
Fax: (770) 754-9881

The NPI 1720174873 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 10/5/2006 and was last updated on 7/26/2013.

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 Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice		2002456A	INDIANA	No
2	208D00000X	General Practice		58478	GEORGIA	Yes

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 Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	01BCHWH	MEDICARE PIN	GEORGIA

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

NPI Synchronization or Removal

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