Individual
DR. CIERRA CELESTE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
66 OLD AIRPORT RD, HATTIESBURG, MS 39401
(601) 544-7500
(601) 544-7524
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-8700
(601) 450-2493
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23976
MS
207Q00000X
Family Medicine Physician
4301098722
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04774531
—
MS
01
—
12684749
CAQH
MS
Enumeration date
07/06/2011
Last updated
04/08/2019
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