Individual
JOHN W. GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2562 KINARD ST, NEWBERRY, SC 29108-2910
(803) 276-6689
Mailing address
2562 KINARD ST, NEWBERRY, SC 29108-2910
(803) 276-6689
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8843
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
088434
—
SC
Enumeration date
12/26/2006
Last updated
07/08/2007
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