Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN247066 | GA |
NPI | 1003424151 |
---|---|
Provider Name | Meagan Green |
First Address | Atlanta, GA 30322-1060 |
Second Address | Atlanta, GA 30322-1060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2020 |
Last Update Date | 15/07/2020 |