Provider Demographics
NPI:1194978270
Name:HUBBARD-GREEN, DENEEK B (APRN)
Entity type:Individual
Prefix:MRS
First Name:DENEEK
Middle Name:B
Last Name:HUBBARD-GREEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2587 CAPTAINS ROW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-3062
Mailing Address - Country:US
Mailing Address - Phone:205-915-2157
Mailing Address - Fax:
Practice Address - Street 1:1365 CLIFTON ROAD NE
Practice Address - Street 2:CLINIC A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-778-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-03
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197288363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner