Individual
MS. KIMBERLY DAINELLE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
761 POPLAR ST, SUITE # 2 I, MACON, GA 31201-2082
(478) 461-1955
(478) 745-2054
Mailing address
761 POPLAR ST, SUITE # 2 I, MACON, GA 31201-2082
(478) 461-1955
(478) 745-2054
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
011-R-0210
GA
Other
Enumeration date
07/12/2011
Last updated
07/12/2011
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