Individual
TAMMY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
5040 BILL GARDNER PKWY, SUITE 100, LOCUST GROVE, GA 30248-3757
(678) 583-5437
(678) 583-5484
Mailing address
1002 SUMMERLAKE WAY, MCDONOUGH, GA 30253-7424
(404) 669-7949
(678) 583-5484
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN199156
GA
363LP0200X
Pediatric Nurse Practitioner
RN199156
GA
Other
Enumeration date
01/29/2016
Last updated
02/03/2016
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