Provider Demographics
NPI:1770531915
Name:GREEN, GEORGE CAMERON (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:CAMERON
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SPAULDING RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-5116
Mailing Address - Country:US
Mailing Address - Phone:828-659-5459
Mailing Address - Fax:828-659-9518
Practice Address - Street 1:100 SPAULDING RD STE 1
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-5116
Practice Address - Country:US
Practice Address - Phone:828-659-5459
Practice Address - Fax:828-659-9518
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34017174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5077460001OtherPALMETTO GOV BENEFITS NUM
NC891357EMedicaid
NC36931OtherBLUE CROSS OF NC PROVIDER
NC36931OtherBLUE CROSS OF NC PROVIDER
NCC67300Medicare UPIN