Individual
DR. DOUGLASS W 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
207RN0300X
Nephrology Physician
Primary
015559
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
082790
ANTHEM
VA
01
—
3037797
BC
TN
05
—
6016502
—
VA
Enumeration date
07/01/2005
Last updated
06/11/2014
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