Provider Demographics
NPI:1063903995
Name:GREEN, MICHAEL JAMIEL
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JAMIEL
Last Name:GREEN
Suffix:
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:PO BOX 9424
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-9424
Mailing Address - Country:US
Mailing Address - Phone:757-618-3273
Mailing Address - Fax:
Practice Address - Street 1:3816 SCHOONER TRL
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-3215
Practice Address - Country:US
Practice Address - Phone:757-618-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-26
Last Update Date:2018-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)