Individual
DR. ROBERT L. GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2501 N PATTERSON ST, VALDOSTA, GA 31602-1735
(229) 433-1000
(706) 596-6723
Mailing address
PO BOX 1524, COLUMBUS, GA 31902-1524
(800) 841-4236
(706) 596-6723
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101042362
VA
2085R0202X
Diagnostic Radiology Physician
Primary
082121
GA
2085R0202X
Diagnostic Radiology Physician
82121
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003218661A
—
GA
05
—
7206941
—
VA
05
—
7251505
—
VA
Enumeration date
07/12/2006
Last updated
10/22/2020
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