Individual
DR. KIMBERLY MICHELLE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
125 QUEENS RD STE 600, CHARLOTTE, NC 28204-3215
(980) 302-6600
(980) 302-6605
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
53728
CO
207RH0003X
Hematology & Oncology Physician
Primary
2020-00647
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
410521
—
SC
Enumeration date
04/14/2008
Last updated
11/18/2020
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