Provider Demographics
NPI:1134503774
Name:GREEN, MATTHEW COREY
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:COREY
Last Name:GREEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CAHABA VALLEY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-1185
Mailing Address - Country:US
Mailing Address - Phone:205-621-3778
Mailing Address - Fax:205-621-4835
Practice Address - Street 1:120 CAHABA VALLEY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PELHAM
Practice Address - State:AL
Practice Address - Zip Code:35124-1185
Practice Address - Country:US
Practice Address - Phone:205-621-3778
Practice Address - Fax:205-621-4835
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-139417363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care