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
Health care specialties
| Specialty | Code | License # | 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 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073719803 | NPPES |
| Mississippi | Other | 512I360002 | PTAN |
| Mississippi | MEDICAID | 179024 | PTAN |
| Mississippi | Other | P01195515 | PTAN |
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