Provider Demographics
NPI:1689151987
Name:GREEN-SMITH, PAULA SUE (MA)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:SUE
Last Name:GREEN-SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 W GRAND BLVD STE 531
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3008
Mailing Address - Country:US
Mailing Address - Phone:313-664-0100
Mailing Address - Fax:313-664-0111
Practice Address - Street 1:3031 W GRAND BLVD STE 531
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3008
Practice Address - Country:US
Practice Address - Phone:131-366-4010
Practice Address - Fax:313-664-0111
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator