Provider Demographics
NPI:1508944125
Name:GREEN, JULIET E (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JULIET
Middle Name:E
Last Name:GREEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1532
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514
Mailing Address - Country:US
Mailing Address - Phone:706-745-6292
Mailing Address - Fax:706-745-6803
Practice Address - Street 1:55 HUGHES ST
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3551
Practice Address - Country:US
Practice Address - Phone:706-745-6292
Practice Address - Fax:706-745-6803
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN049038164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse