Provider Demographics
NPI:1154609923
Name:GREEN, JASON WESLEY (DO)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WESLEY
Last Name:GREEN
Suffix:
Gender:M
Credentials:DO
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 440010
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0010
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:
Practice Address - Street 1:1940 ALCOA HWY STE 210
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2264
Practice Address - Country:US
Practice Address - Phone:423-794-9400
Practice Address - Fax:865-305-6563
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3480207RC0200X, 207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program