Individual
BROOKLYN WALSH GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 MIMOSA DR FL 2, THOMASVILLE, GA 31792-6676
(229) 228-5500
(229) 584-5985
Mailing address
100 MIMOSA DR FL 2, THOMASVILLE, GA 31792-6676
(229) 228-5500
(229) 584-5985
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12179
GA
363A00000X
Physician Assistant
PA9114960
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12179
GEORGIA MEDICAL LICENSE NO.
GA
01
—
PA9114960
FLORIDA MEDICAL LICENSE NO.
FL
Enumeration date
03/24/2021
Last updated
04/20/2024
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