Individual
MRS. GEORGIA LEE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
312 JANET DAVIS CIRCLE, INDIANOLA, MS 38751-3753
(662) 207-3020
Mailing address
312 JANET DAVIS CIRCLE, INDIANOLA, MS 38751-3753
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P281148
MS
Other
Enumeration date
05/06/2021
Last updated
05/06/2021
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