Raymond B Green, RPT

Primary specialty

Phlebotomy TechnicianTaxonomy code 246RP1900X

License

12946819 Issued in GA

Practice address

1575 Elm St NE
Conyers, GA 30012-3715

Phone

(770) 864-8806

NPI assigned

Nov 14, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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": "1542153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637020800000",
    "number": "1316416860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 ELM ST NE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123715",
            "telephone_number": "770-864-8806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 ELM ST NE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300123715",
            "telephone_number": "770-864-8806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "RAYMOND",
        "middle_name": "B",
        "name_prefix": "Mr.",
        "credential": "RPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-11-14",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246RP1900X",
            "taxonomy_group": "",
            "desc": "Technician, Pathology, Phlebotomy",
            "state": "GA",
            "license": "12946819",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316416860",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "preciselabs78@gmail.com",
            "affiliation": "N",
            "address_1": "1575 Elm St NE",
            "city": "Conyers",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300123715",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Brett C Gray, DMD MD
• Greater Anesthesia Services LLC
• Green Emerald Home Care Services
• Gilbert Jermaine Green
• Nakalea Green
• Victoria Carriesa Green, NP
• Esther Maria Greene, RN, BSN, CCE
• Jenise Tehvon Greene
• Regina Greenfield, CRNA
• Sasha Gresham, CNA

• Phlebotomy Technician in Conyers, GA
• Providers in Conyers, GA by specialty
• Phlebotomy Technician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; 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.