Green, Kelly D

Green, Kelly D is an individual health care provider with primary practice located at 145 Innovation Dr , Jackson TN 38305-3019. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Cardiovascular Disease is his primary health care specialty. Green, Kelly D can be contacted via phone (731) 422-0213.

Contact Information

Primary practice address
145 Innovation Dr Jackson TN 38305-3019
Phone: (731) 422-0213
Fax: (731) 422-0409
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 45891 Tennessee
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 45891 Tennessee

Profile Details

NPI number 1790909489
LBN Legal business name Green, Kelly D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 12th, 2007
Last updated Oct 25th, 2023 - 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790909489 NPPES
Tennessee MEDICAID 1521978
Tennessee Other P01391750

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