Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251E1200X | Ergonomics | 0000003798 | TN |
Y | 225XE1200X | Ergonomics | 0000003798 | TN |
NPI | 1144794348 |
---|---|
Provider Name | Jimmmye Dale Green JR. |
First Address | Holly Springs, MS 38635-9744 |
Second Address | Maryville, TN 37804-3643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2019 |
Last Update Date | 22/01/2019 |