Provider Demographics
NPI:1467491266
Name:GREEN, JOHN III (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:GREEN
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 GUILFORD FOREST DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-9005
Mailing Address - Country:US
Mailing Address - Phone:404-691-6149
Mailing Address - Fax:
Practice Address - Street 1:6333 HIGHWAY 49
Practice Address - Street 2:SUITE 7 ACHIEVE MEDICAL WEIGHT LOSS
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3132
Practice Address - Country:US
Practice Address - Phone:601-255-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056998207Q00000X
PAOS008848L207Q00000X
MS21492207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine