Provider Demographics
NPI:1205289196
Name:GREEN, JOY LAVERN (PA)
Entity type:Individual
Prefix:MRS
First Name:JOY
Middle Name:LAVERN
Last Name:GREEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:3419 SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2314
Mailing Address - Country:US
Mailing Address - Phone:202-744-3843
Mailing Address - Fax:
Practice Address - Street 1:4700 EXCHANGE CT STE 110
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4450
Practice Address - Country:US
Practice Address - Phone:561-247-5907
Practice Address - Fax:561-431-2821
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0006224363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant