Individual
CAROLYN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1214 COOLIDGE STREET, NEW IBERIA, LA 70507
(337) 289-7172
Mailing address
P O BOX 404282, ATLANTA, GA 30384
(770) 874-5400
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
12485R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1534412
—
LA
Enumeration date
09/22/2006
Last updated
07/09/2007
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