Individual
BRODY MITCHELL GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPTA
Contact information
Practice address
4580 TOWNE LAKE PKWY, WOODSTOCK, GA 30189
(678) 771-6459
Mailing address
1824 DEFOOR AVE NW APT 2215, ATLANTA, GA 30318-3029
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA004106
GA
Other
Enumeration date
03/07/2019
Last updated
03/07/2019
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