Provider Demographics
NPI:1518991496
Name:GREEN, MICHAEL FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANKLIN
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 ST SEBASTIAN WAY
Mailing Address - Street 2:STE 403
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901
Mailing Address - Country:US
Mailing Address - Phone:706-722-0705
Mailing Address - Fax:706-722-7315
Practice Address - Street 1:818 ST SEBASTIAN WAY
Practice Address - Street 2:STE 403
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-722-0705
Practice Address - Fax:706-722-7315
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23972208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00270212BMedicaid
D40010Medicare UPIN
34BDFBCMedicare ID - Type Unspecified