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Individual

VIRGINIA ANN GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPN

Contact information

Practice address
2997 OLD LODGE RD, HEPHZIBAH, GA 30815-4994
(706) 791-1687
(706) 791-1683
Mailing address
BLDG 14401 15TH & LANE STREET, FORT GORDON, GA 30905
(706) 791-1687
(706) 761-1683

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN063962
GA

Other

Enumeration date
04/30/2012
Last updated
04/30/2012
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