Provider Demographics
NPI:1871838755
Name:GREEN, HARBERT NOEL (RN)
Entity Type:Individual
Prefix:MR
First Name:HARBERT
Middle Name:NOEL
Last Name:GREEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:HARBERT
Other - Middle Name:NOEL
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:270 TRELAWNEY DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-6819
Mailing Address - Country:US
Mailing Address - Phone:770-655-8360
Mailing Address - Fax:
Practice Address - Street 1:270 TRELAWNEY DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-6819
Practice Address - Country:US
Practice Address - Phone:770-655-8360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN226286163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN226286OtherNURSING CARE
GARN226285Medicaid