Individual
SANDY CHARLES GREEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDHS
Contact information
Practice address
4000 COAST GUARD BLVD, PORTSMOUTH, VA 23703-2135
(757) 483-8784
Mailing address
4000 COAST GUARD BLVD, PORTSMOUTH, VA 23703-2135
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
CA
Other
Enumeration date
04/17/2025
Last updated
04/17/2025
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