Individual
KELLY D GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
145 INNOVATION DR, JACKSON, TN 38305-3019
(731) 422-0213
(731) 422-0409
Mailing address
PO BOX 400, JACKSON, TN 38302-0400
(731) 425-5752
(731) 425-5783
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
45891
TN
207RC0000X
Cardiovascular Disease Physician
Primary
45891
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1521978
—
TN
01
—
P01391750
RRMC
TN
Enumeration date
04/12/2007
Last updated
10/25/2023
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