Individual
KELLY DOUGLAS GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2900 HAWKINS DR, SEARCY, AR 72143-4802
(501) 278-2800
(501) 278-3073
Mailing address
2900 HAWKINS DR, SEARCY, AR 72143-4802
(501) 278-2800
(501) 278-3073
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
2002010422
MO
207T00000X
Neurological Surgery Physician
Primary
E-9196
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1159308
CAQH
—
Enumeration date
01/20/2007
Last updated
01/08/2021
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