Organization
GREENLINE MEDICAL CORPORATION
Active
Other names
Eagle Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIMBERLY GREEN D.O. (PHYSICIAN)
(770) 754-9880
Entity
Organization
Contact information
Practice address
804 BOMBAY LN, ROSWELL, GA 30076-5819
(770) 754-9880
(770) 754-9881
Mailing address
804 BOMBAY LN, ROSWELL, GA 30076-5819
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
058478
GA
208VP0000X
Pain Medicine Physician
058478
GA
Other
Enumeration date
02/19/2011
Last updated
02/19/2011
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