Provider Demographics
NPI:1194914580
Name:MARGARET O. GREEN,M.D.,P.C.
Entity type:Organization
Organization Name:MARGARET O. GREEN,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:B
Authorized Official - Last Name:TUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-774-7550
Mailing Address - Street 1:1303 DANTIGNAC ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2777
Mailing Address - Country:US
Mailing Address - Phone:706-774-7550
Mailing Address - Fax:706-774-7580
Practice Address - Street 1:1303 DANTIGNAC ST STE 2100
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2777
Practice Address - Country:US
Practice Address - Phone:706-774-7550
Practice Address - Fax:706-774-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16235207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP5105Medicare PIN