Individual
MR. DALLAS ALEXANDER GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5101
Mailing address
116 ASHWOOD CT, LEESBURG, GA 31763-4415
(229) 886-2930
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2023
Last updated
04/07/2023
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