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Organization
SOUTH SOUND MEDICAL GROUP, PLLC
Active
Organization
SOUTH SOUND MEDICAL GROUP, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA VAN FLEET-GREEN M.D. (OWNER/MD)
(360) 556-8465
Entity
Organization
Contact information
Practice address
10116 COACHMAN LN SE, OLYMPIA, WA 98501-9731
(360) 556-8465
Mailing address
10116 COACHMAN LN SE, OLYMPIA, WA 98501-9731
(360) 556-8465
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60162757
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1679736318
NPI
WA
05
—
1679736318
—
WA
Enumeration date
07/17/2015
Last updated
09/23/2015
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