# GREEN MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801086715
- **Authorized official:** DR. LAWRENCE CHARLES GREEN M.D. (OWNER)
- **Authorized official phone:** (918) 456-8989

## Contact information

- **Practice address:** 23507 EAST RIVERVIEW DRIVE, COOKSON, OK 74427
- **Practice address phone:** (918) 456-8989
- **Practice address fax:** (918) 456-7989
- **Mailing address:** 1 PLAZA SOUTH ST, TAHLEQUAH, OK 74464-4750
- **Mailing address phone:** (918) 456-8989
- **Mailing address fax:** (918) 456-7989

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 9260 | OK | Yes |

## Other

- **Enumeration date:** 07/26/2007
- **Last updated:** 11/01/2012