Provider Demographics
NPI:1275252587
Name:GREEN, GEORGIA N (RRT)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:N
Last Name:GREEN
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14205 ROCKY BRIAR LN
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583-2081
Mailing Address - Country:US
Mailing Address - Phone:832-338-4070
Mailing Address - Fax:
Practice Address - Street 1:14205 ROCKY BRIAR LN
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583-2081
Practice Address - Country:US
Practice Address - Phone:832-338-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227800000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified