Provider Demographics
NPI:1245548445
Name:GREEN, PAMELA MICHELE (MED)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MICHELE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 NORWICH DR.
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27420
Mailing Address - Country:US
Mailing Address - Phone:919-633-1895
Mailing Address - Fax:
Practice Address - Street 1:49 NORWICH DR.
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27420
Practice Address - Country:US
Practice Address - Phone:919-633-1895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management