Individual
MRS. MARY FISHER GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1120 15TH ST # AF-2044, AUGUSTA, GA 30912-3040
(706) 721-3548
Mailing address
3030 CARDINAL DR, AUGUSTA, GA 30909-3040
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006983
GA
Other
Enumeration date
10/22/2013
Last updated
10/22/2013
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