Provider Demographics
NPI:1972594539
Name:GREEN, ARTHUR (DO)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3240
Mailing Address - Country:US
Mailing Address - Phone:770-934-7876
Mailing Address - Fax:678-990-7236
Practice Address - Street 1:2545 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3240
Practice Address - Country:US
Practice Address - Phone:770-934-7876
Practice Address - Fax:678-990-7236
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013565207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00024637AMedicaid
GAD40008Medicare UPIN
GA11BDFXCMedicare ID - Type Unspecified