Greenline Medical Corporation

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

058478 Issued in GA

Legal business name

GREENLINE MEDICAL CORPORATION

Doing business as

Eagle Medical Center

Practice address

804 Bombay LN
Roswell, GA 30076-5819

Phone

(770) 754-9880

Fax

(770) 754-9881

NPI assigned

Feb 19, 2011

Last updated

Feb 19, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kimberly Green, D.O.NPI 1720174873

Title

Physician

Phone

(770) 754-9880

Specialties & licenses 2

Addresses

Other names 1

• Eagle Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kimberly J Green, D.O

  • General Practice Physician
  • Alpharetta, GA
  • NPI 1720174873
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298073600000",
    "number": "1073810453",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "804 BOMBAY LN",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 BOMBAY LN",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300765819",
            "telephone_number": "770-754-9880",
            "fax_number": "770-754-9881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENLINE MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-19",
        "last_updated": "2011-02-19",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "770-754-9880",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "058478",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "GA",
            "license": "058478",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eagle Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• William Shelton Green, ATC
• Kathleen O'Neill Greene, PT
• Susan A Greene, APRN-BC
• Tamara S Greene, M.D.
• Victoria Greene, RBT
• Mark Greenspan, MSPT
• Jodi M. Greenwald, M.D.
• Theresia Lynn Greer, LMT
• Timothy M Gregory, DC
• Stephanie Gresham

• General Practice Physician in Roswell, GA
• Providers in Roswell, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.