Provider Demographics
NPI:1568860955
Name:GREEN, BRITTANY (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:BRITTANY
Other - Middle Name:ERIN
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:1061 HARMON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-5641
Mailing Address - Country:US
Mailing Address - Phone:912-435-6965
Mailing Address - Fax:
Practice Address - Street 1:1272 W MAIN ST BLDG 1
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-2053
Practice Address - Country:US
Practice Address - Phone:614-900-5017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-17
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001359213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery