Provider Demographics
NPI:1407898372
Name:GREEN, TERRI YARBROUGH (MD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:YARBROUGH
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1326
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1326
Mailing Address - Country:US
Mailing Address - Phone:870-930-3518
Mailing Address - Fax:870-930-3569
Practice Address - Street 1:411 E MATTHEWS AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-3142
Practice Address - Country:US
Practice Address - Phone:870-930-3518
Practice Address - Fax:870-930-3569
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3842207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR52119OtherBLUE CROSS BLUE SHIELD
AR52119OtherBLUE CROSS BLUE SHIELD
AR52119Medicare ID - Type Unspecified