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Individual

JEFFERY TYLER GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
500 MARTHA JEFFERSON DR, CHARLOTTESVILLE, VA 22911-4668
(770) 265-6081
Mailing address
PO BOX 480, LIMA, OH 45802-0480
(866) 223-6316
(419) 223-2726

Taxonomy

Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0101248582
VA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
71709
GA

Other

Enumeration date
04/28/2009
Last updated
03/16/2021
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