Provider Demographics
NPI:1265887350
Name:GREEN, KARLITA
Entity type:Individual
Prefix:
First Name:KARLITA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1928 ABBEYDALE LN
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-2942
Mailing Address - Country:US
Mailing Address - Phone:910-920-7506
Mailing Address - Fax:910-676-8576
Practice Address - Street 1:1928 ABBEYDALE LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2942
Practice Address - Country:US
Practice Address - Phone:910-920-7506
Practice Address - Fax:910-676-8576
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8121384121744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management