Provider Demographics
NPI:1366564379
Name:GREEN, CYNTHIA FAYE
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:FAYE
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3272 SPRING MESA CT
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-4771
Mailing Address - Country:US
Mailing Address - Phone:404-992-6645
Mailing Address - Fax:
Practice Address - Street 1:3272 SPRING MESA CT
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4771
Practice Address - Country:US
Practice Address - Phone:404-992-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator