Provider Demographics
NPI:1073113668
Name:GREEN, SHERITA PATRICIA (LPN/RCIS)
Entity Type:Individual
Prefix:
First Name:SHERITA
Middle Name:PATRICIA
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPN/RCIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 BRADY RD
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-5541
Mailing Address - Country:US
Mailing Address - Phone:229-395-1092
Mailing Address - Fax:
Practice Address - Street 1:397 BRADY ROAD
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709
Practice Address - Country:US
Practice Address - Phone:229-395-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA343900000XOtherTAXONOMY