Individual
MR. JUSTUS ISHMAEL GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
975 E 3RD ST, CHATTANOOGA, TN 37403-2147
(423) 602-8400
(423) 602-8401
Mailing address
PO BOX 2930, INDIANAPOLIS, IN 46206-2930
(844) 468-9496
(855) 630-1300
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
212712
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
212712
TN STATE RN LICENSE NUMBER
TN
Enumeration date
09/10/2018
Last updated
09/10/2018
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