Provider Demographics
NPI:1609338326
Name:GREEN WOOD BERRY HOLDINGS LLC
Entity Type:Organization
Organization Name:GREEN WOOD BERRY HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-538-2348
Mailing Address - Street 1:509 GRAMERCY DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4873
Mailing Address - Country:US
Mailing Address - Phone:404-538-2348
Mailing Address - Fax:
Practice Address - Street 1:509 GRAMERCY DR NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4873
Practice Address - Country:US
Practice Address - Phone:404-538-2348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies