| Green Clinic P.c. | |
|
5220 Park Ave Ste 150 Memphis TN 38119-3548 | |
| (901) 755-2255 | |
| (901) 755-9566 |
| Full Name | Green Clinic P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 5220 Park Ave Ste 150, Memphis, Tennessee |
| Authorized Official Name and Position | Christopher Brian Green (PRESIDENT/OWNER) |
| Authorized Official Contact | 9017552255 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Clinic P.c. 5220 Park Ave Ste 150 Memphis TN 38119-3548 Ph: (901) 755-2255 | Green Clinic P.c. 5220 Park Ave Ste 150 Memphis TN 38119-3548 Ph: (901) 755-2255 |
| NPI Number | 1306018791 |
|---|---|
| Provider Enumeration Date | 03/26/2008 |
| Last Update Date | 10/30/2018 |
| Medicare PECOS PAC ID | 6406818392 |
|---|---|
| Medicare Enrollment ID | O20041102001085 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306018791 | NPI | - | NPPES |
| 3720127 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD25222 (Tennessee) | Primary |
| Provider Name | Christopher B Green |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1700897774 PECOS PAC ID: 7113989005 Enrollment ID: I20051207000952 |
| Provider Name | Sharon Little |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922126150 PECOS PAC ID: 0749334522 Enrollment ID: I20090812000941 |
| Provider Name | Mary E Tullos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639339682 PECOS PAC ID: 6608906607 Enrollment ID: I20151111000054 |
| Provider Name | Bridget Lashundra Hopson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477005429 PECOS PAC ID: 8022391770 Enrollment ID: I20170203001516 |
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