Green, Diane Elaine

Green, Diane Elaine is an individual health care provider with primary practice located at 708 W Forest Ave , Jackson TN 38301-3901. She recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as her primary health care specialty. Green, Diane Elaine can be contacted via phone (731) 660-8759.

Contact Information

Primary practice address
708 W Forest Ave Jackson TN 38301-3901
Phone: (731) 660-8759
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X 13431 Tennessee

Profile Details

NPI number 1538136148
LBN Legal business name Green, Diane Elaine
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 2nd, 2006
Last updated Jul 17th, 2009 - about 17 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 1538136148 NPPES
Tennessee MEDICAID 3188084
Tennessee MEDICAID 3188088
Tennessee Other 220016966
Tennessee Other 3067959
Tennessee MEDICAID 3188085

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