Provider Demographics
NPI:1104574821
Name:GREENE, ANGELA DAWN (NP-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:DAWN
Last Name:GREENE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 TRANSIT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2544
Mailing Address - Country:US
Mailing Address - Phone:770-720-7000
Mailing Address - Fax:770-720-7055
Practice Address - Street 1:720 TRANSIT AVE STE 101
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2544
Practice Address - Country:US
Practice Address - Phone:770-720-7000
Practice Address - Fax:770-720-7055
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN117392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily