Provider Demographics
NPI:1194084442
Name:GREEN, JONATHAN EDWARD (R EP T, CNIM)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:EDWARD
Last Name:GREEN
Suffix:
Gender:M
Credentials:R EP T, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 MURPHY AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2023
Mailing Address - Country:US
Mailing Address - Phone:615-768-9494
Mailing Address - Fax:
Practice Address - Street 1:2011 MURPHY AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2023
Practice Address - Country:US
Practice Address - Phone:615-768-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1996OtherCNIM