Provider Demographics
NPI:1134814577
Name:GREEN, TERRY BERNARD II
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:BERNARD
Last Name:GREEN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 BRUNSON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1758
Mailing Address - Country:US
Mailing Address - Phone:614-815-9352
Mailing Address - Fax:
Practice Address - Street 1:500 MADISON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1222
Practice Address - Country:US
Practice Address - Phone:567-312-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator