Provider Demographics
NPI:1265807135
Name:GREEN, DAMIKA (RRT)
Entity type:Individual
Prefix:MRS
First Name:DAMIKA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 GARRISON LN
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-7021
Mailing Address - Country:US
Mailing Address - Phone:404-604-0640
Mailing Address - Fax:
Practice Address - Street 1:3073 PANTHERSVILLE RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3828
Practice Address - Country:US
Practice Address - Phone:404-244-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0088449227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered