Brody Mitchell Green, LPTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA004106 Issued in GA

Practice address

4580 Towne Lake Pkwy
Woodstock, GA 30189

Phone

(678) 771-6459

NPI assigned

Mar 7, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1551916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551916800000",
    "number": "1154889129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1824 DEFOOR AVE NW APT 2215",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303183029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4580 TOWNE LAKE PKWY",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "30189",
            "telephone_number": "678-771-6459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "BRODY",
        "middle_name": "MITCHELL",
        "credential": "LPTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-07",
        "last_updated": "2019-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA004106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grainne Transportation LLC
• Samantha Liane Grant, MBBS
• Angela M Graves
• Kimber Gray, M.ED. CCC-SLP
• Theresa Gray, LMSW
• Lana Danielle Greene, MA, LPC, NCC
• Haley Greenlee
• Gregg Chiropractic Center, Inc.
• Brian Glen Gregg, DC
• Jackson Kelley Griffeth, DMD, MSD

• Physical Therapy Assistant in Woodstock, GA
• Providers in Woodstock, GA by specialty
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.