Individual
DR. CLYDE O. GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
841 MULBERRY ST, MACON, GA 31201-6756
(478) 741-6554
(478) 743-7052
Mailing address
841 MULBERRY ST, MACON, GA 31201-6756
(478) 741-6554
(478) 743-7052
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30072
GA
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
30072
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00358432 D, E, F, J
—
GA
01
—
105116
PEACH STATE
GA
01
—
1451889
UNITED HEALTH CARE
GA
01
—
157763300
WORKER COMP
GA
01
—
157763301
WORKERS COMP
GA
01
—
157763302
WORKERS COMP
GA
01
—
324341
WELLCARE
GA
01
—
508457
BLUE CROSS BLUE SHIELD
GA
01
—
D45482GRE00
SECURE CHOICE HEALTH
GA
Enumeration date
05/01/2007
Last updated
01/21/2015
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