Individual
DR. JOHN A GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL PARK BLVD, SUITE 450W, BRISTOL, TN 37620-7430
(423) 968-3713
(423) 968-7352
Mailing address
PO BOX 9, KINGSPORT, TN 37662-0009
(423) 857-2066
(423) 857-2070
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
011243
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014531
ANTHEM
VA
01
—
3037795
BLUE CROSS
TN
05
—
6093752
—
VA
Enumeration date
07/08/2005
Last updated
06/11/2014
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