Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 074287 | GA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | DO2176 | TN |
NPI | 1275867715 |
---|---|
Provider Name | Dr. Brandon Green |
First Address | Johnson City, TN 37615-4191 |
Second Address | Johnson City, TN 37604-6971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2009 |
Last Update Date | 23/09/2016 |