| Greenstones Pllc | |
|
901 Highway 80 E Clinton MS 39056-5244 | |
| (601) 488-9668 | |
| Not Available |
| Full Name | Greenstones Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 901 Highway 80 E, Clinton, Mississippi |
| Authorized Official Name and Position | Lakeisha Green (OWNER) |
| Authorized Official Contact | 6014889668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenstones Pllc 901 Highway 80 E Clinton MS 39056-5244 Ph: (601) 488-9668 | Greenstones Pllc 901 Highway 80 E Clinton MS 39056-5244 Ph: (601) 488-9668 |
| NPI Number | 1336641091 |
|---|---|
| Provider Enumeration Date | 03/08/2018 |
| Last Update Date | 08/04/2021 |
| Certification Date | 08/04/2021 |
| Medicare PECOS PAC ID | 2860755733 |
|---|---|
| Medicare Enrollment ID | O20180406002115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336641091 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | R890966 (Mississippi) | Primary |
| Provider Name | Lakeisha Crye Green |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114311446 PECOS PAC ID: 9436470812 Enrollment ID: I20150610002542 |
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