Individual
MR. BLAKE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
80 JESSE HILL JR DR SE, ATLANTA, GA 30303-3031
(404) 616-9153
(404) 616-3066
Mailing address
80 JESSE HILL JR DR SE, ATLANTA, GA 30303-3031
(404) 616-9153
(404) 616-3066
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN164761
GA
Other
Enumeration date
08/06/2012
Last updated
08/06/2012
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