Individual
CAROLYN JOY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
125 PROFESSIONAL PARK DR, SENECA, SC 29678-2558
(864) 482-3000
(864) 482-4000
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2012003986
MO
363A00000X
Physician Assistant
Primary
5094
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972876738
—
MO
Enumeration date
02/09/2012
Last updated
01/23/2024
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