Provider Demographics
NPI:1841495751
Name:GREEN, NATASHA QUINTA
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:QUINTA
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 1:4068 EMERALD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-2735
Mailing Address - Country:US
Mailing Address - Phone:318-518-1686
Mailing Address - Fax:
Practice Address - Street 1:4068 EMERALD LAKE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2735
Practice Address - Country:US
Practice Address - Phone:318-518-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005083235Z00000X, 235Z00000X
NC7392235Z00000X
TX18467235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist