Provider Demographics
NPI:1740030071
Name:GREEN, JAMES OLIVER JR
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:OLIVER
Last Name:GREEN
Suffix:JR
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 1:113 CEDAR WOODS TRL
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7769
Mailing Address - Country:US
Mailing Address - Phone:678-431-5891
Mailing Address - Fax:
Practice Address - Street 1:113 CEDAR WOODS TRL
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7769
Practice Address - Country:US
Practice Address - Phone:678-431-5891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator