Provider Demographics
NPI:1114303567
Name:GREEN ANGEL HEALTHCARE CONSULTING, INC.
Entity Type:Organization
Organization Name:GREEN ANGEL HEALTHCARE CONSULTING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELLA
Authorized Official - Middle Name:DININA
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:404-452-2519
Mailing Address - Street 1:4760 AUSTELL RD, SUITE 3
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-4007
Mailing Address - Country:US
Mailing Address - Phone:404-452-2519
Mailing Address - Fax:678-252-6427
Practice Address - Street 1:4760 AUSTELL RD, SUITE #3
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-4007
Practice Address - Country:US
Practice Address - Phone:404-452-2519
Practice Address - Fax:678-252-6427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-08
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA186231261QP2300X
363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care