Individual
TASHA LAVETTE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
125 EAGLES WALK, SUITE 150, STOCKBRIDGE, GA 30281-7208
(678) 477-9230
Mailing address
4228 ABRAM DR, CONLEY, GA 30288-1739
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
052108
GA
Other
Enumeration date
07/13/2006
Last updated
03/22/2017
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