Provider Demographics
NPI:1225550619
Name:GREEN, LAMARIA MICHELLE
Entity Type:Individual
Prefix:MS
First Name:LAMARIA
Middle Name:MICHELLE
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PROMETHEOUS WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-8036
Mailing Address - Country:US
Mailing Address - Phone:678-246-8808
Mailing Address - Fax:
Practice Address - Street 1:52 PROMETHEOUS WAY
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153
Practice Address - Country:US
Practice Address - Phone:678-246-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0030020277171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator