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Individual

MARK S GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
1847 S LAKE DR, LEXINGTON, SC 29073-7759
(803) 356-8998
Mailing address
PO BOX 749306, ATLANTA, GA 30374-9306

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002321
GA
363A00000X
Physician Assistant
Primary
560
SC

Other

Enumeration date
10/31/2005
Last updated
02/10/2025
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