# GREENLINE MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Eagle Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073810453
- **Authorized official:** DR. KIMBERLY GREEN D.O. (PHYSICIAN)
- **Authorized official phone:** (770) 754-9880

## Contact information

- **Practice address:** 804 BOMBAY LN, ROSWELL, GA 30076-5819
- **Practice address phone:** (770) 754-9880
- **Practice address fax:** (770) 754-9881
- **Mailing address:** 804 BOMBAY LN, ROSWELL, GA 30076-5819

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 058478 | GA | Yes |
| 208VP0000X | Pain Medicine Physician | 058478 | GA | — |

## Other

- **Enumeration date:** 02/19/2011
- **Last updated:** 02/19/2011