Provider Demographics
NPI:1871709840
Name:GREEN, JAMES ELLIS (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ELLIS
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7970
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504
Mailing Address - Country:US
Mailing Address - Phone:770-535-7978
Mailing Address - Fax:770-535-8050
Practice Address - Street 1:526 PEARL NIX PARKWAY
Practice Address - Street 2:SUITE #103
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-535-7978
Practice Address - Fax:770-535-8050
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAG027200208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD0330448AMedicaid
GAD0330448AMedicaid