Provider Demographics
NPI:1699725671
Name:GREEN, LINDA HAYNIE (MD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:HAYNIE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 STEMLEY BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35128-7519
Mailing Address - Country:US
Mailing Address - Phone:205-338-7662
Mailing Address - Fax:205-884-8862
Practice Address - Street 1:4103 STEMLEY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35128-7519
Practice Address - Country:US
Practice Address - Phone:205-338-7662
Practice Address - Fax:205-884-8862
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26919207RG0300X
ARC-4828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL630412147Medicaid
AL630400147Medicaid
AL630408147Medicaid
AL630410147Medicaid
AL630410147Medicaid
AL630400147Medicaid