Provider Demographics
NPI:1386123743
Name:GREEN, MILTON JR
Entity type:Individual
Prefix:MR
First Name:MILTON
Middle Name:
Last Name:GREEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 JEWELL CT
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6069
Mailing Address - Country:US
Mailing Address - Phone:678-923-6502
Mailing Address - Fax:678-550-9211
Practice Address - Street 1:110 JEWELL CT
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6069
Practice Address - Country:US
Practice Address - Phone:678-923-6502
Practice Address - Fax:678-550-9211
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)