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Organization

EVERGREEN PSYCHIATRY GROUP PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARIAM NANTANG (OWNER)
(743) 222-9755
Entity
Organization

Contact information

Practice address
717 GREEN VALLEY RD STE 200, GREENSBORO, NC 27408-2156
(743) 222-9755
Mailing address
717 GREEN VALLEY RD STE 200, GREENSBORO, NC 27408-2156
(743) 222-9755

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
261QM1300X
Multi-Specialty Clinic/Center
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Enumeration date
01/23/2025
Last updated
01/23/2025
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