Provider Demographics
NPI:1184646929
Name:GREEN, ERIC BRENT (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:BRENT
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 25TH AVE N
Mailing Address - Street 2:SUITE 602
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1606
Mailing Address - Country:US
Mailing Address - Phone:615-312-0612
Mailing Address - Fax:615-312-0612
Practice Address - Street 1:210 25TH AVE N
Practice Address - Street 2:SUITE 602
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1606
Practice Address - Country:US
Practice Address - Phone:615-327-4737
Practice Address - Fax:615-327-4737
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012396812085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3834389Medicaid
TN3834389Medicaid