Provider Demographics
NPI:1982106373
Name:GREEN, VICTORIA CARRIESA (NP)
Entity type:Individual
Prefix:MISS
First Name:VICTORIA
Middle Name:CARRIESA
Last Name:GREEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR STE 203
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 MILSTEAD RD NE STE 110
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3849
Practice Address - Country:US
Practice Address - Phone:770-496-9430
Practice Address - Fax:404-891-4947
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN207510363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care