Individual
MR. JOHNNY RAY GREEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
20214 E ADMIRAL PL APT 732, CATOOSA, OK 74015-3265
(870) 680-0227
Mailing address
20214 E ADMIRAL PL APT 732, CATOOSA, OK 74015-3265
(870) 680-0227
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/25/2022
Last updated
03/25/2022
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