Green, Edward

Green, Edward is an sole proprietor health care provider with primary practice located at 969 Lakeland Dr , Jackson MS 39216-4606. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Green, Edward can be contacted via phone (601) 200-6162.

Contact Information

Primary practice address
969 Lakeland Dr Jackson MS 39216-4606
Phone: (601) 200-6162
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 135313 North Carolina
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 17833 Mississippi

Profile Details

NPI number 1073719803
LBN Legal business name Green, Edward
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 27th, 2007
Last updated Oct 6th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073719803 NPPES
Mississippi Other 512I360002 PTAN
Mississippi MEDICAID 179024 PTAN
Mississippi Other P01195515 PTAN

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