Individual
JEFFERSON ROBERT GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3205 RANDALL PKWY STE 217, WILMINGTON, NC 28403-2569
(910) 877-1598
Mailing address
5306 AUTUMN DR, WILMINGTON, NC 28409-5702
(336) 880-5985
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
P023659
NC
Other
Enumeration date
04/09/2026
Last updated
04/09/2026
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