Individual
ALEXANDER GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
170 W TENNESSEE AVE, OAK RIDGE, TN 37830-6509
(865) 482-1788
Mailing address
170 W TENNESSEE AVE, OAK RIDGE, TN 37830-6509
(865) 482-1788
(865) 482-1789
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
DPM897
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6277909
BCBST
TN
01
—
DPM897
TN PODIATRY BOARD
TN
05
—
Q068463
—
TN
Enumeration date
05/07/2018
Last updated
03/07/2023
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